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Mustafa Çelik
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Down Syndrome Ultrasound vs Normal 20 Weeks
Down Syndrome Ultrasound vs Normal 20 Weeks 4

Down syndrome, also known as Trisomy 21, affects about 1 in 700 babies in the U.S. At 20 weeks, an ultrasound is key in checking for Down syndrome risk. During this scan, doctors look at several soft markers down syndrome ultrasound vs normal 20 weeks.

Important signs at 20 weeks include a thickened nuchal fold, small or absent nasal bone, and shortened femur length. They also check for echogenic bowel. Knowing these signs helps expecting parents understand prenatal screening better.

At Liv Hospital, we use the latest ultrasound tech and care with love. We aim to give families the info and support they need during this important time.

Key Takeaways

  • Down syndrome affects about 1 in 700 births.
  • The 20-week ultrasound checks for Down syndrome risk by looking at soft markers.
  • Important signs include a thickened nuchal fold and shortened femur length.
  • Understanding these signs helps expecting parents understand prenatal screening.
  • Liv Hospital offers advanced ultrasound tech and caring care.

Understanding Down Syndrome

Down Syndrome Ultrasound vs Normal 20 Weeks

Down syndrome is a condition that comes from genetics. It affects many people and families around the world. Knowing its causes and how common it is helps us understand it better.

What is Trisomy 21?

Down syndrome, or Trisomy 21, happens when there’s an extra chromosome 21. This extra piece of DNA changes how a person develops. It’s often clear when a baby is born, because of their unique looks.

Prevalence and Risk Factors

In the U.S., about 1 in 700 babies are born with Down syndrome. The chance of having a child with it goes up after a mom is 35. Other things like family history and certain genetic conditions can also play a part.

Maternal Age

Risk of Down Syndrome

20-24 years

1 in 1,500

25-29 years

1 in 1,100

30-34 years

1 in 350

35-39 years

1 in 250

40-44 years

1 in 100

45 years and older

1 in 30

Importance of Prenatal Detection

Finding out about Down syndrome before a baby is born is very important. Ultrasound and other tests help spot signs of it. This early knowledge helps families get the support they need.

Getting a diagnosis of Down syndrome can change a family’s life. So, it’s key to be kind and supportive to those who are affected.

Prenatal Screening vs. Diagnostic Testing

Down Syndrome Ultrasound vs Normal 20 Weeks

Expectant parents face many tests during pregnancy. It’s key to know the difference between prenatal screening and diagnostic testing. Screening tests look for risks, while diagnostic tests give a clear answer.

We’ll look at prenatal screening and diagnostic tests. This includes Non-Invasive Prenatal Testing (NIPT), Ultrasound Screening, and tests like Amniocentesis and Chorionic Villus Sampling (CVS).

Non-Invasive Prenatal Testing (NIPT)

NIPT is a blood test that checks for chromosomal issues like Down syndrome. It’s safe for the pregnancy. It’s offered to those at high risk for these conditions.

NIPT is very sensitive but not definitive. It can show false results. So, a follow-up test is needed to confirm any findings.

Ultrasound Screening

Ultrasound is a key part of prenatal care. It uses sound waves to show the fetus. The 20-week anatomy scan looks for structural issues, like Down syndrome markers.

Ultrasound can suggest Down syndrome but isn’t sure. Soft markers might show a risk, but they don’t confirm it.

Amniocentesis and CVS

Diagnostic tests like amniocentesis and CVS confirm chromosomal issues. Amniocentesis takes amniotic fluid, while CVS takes a placenta piece. Both carry a small risk of miscarriage.

These tests are for those at high risk. They give a clear diagnosis. This helps parents make informed choices about their pregnancy.

In summary, prenatal screening and diagnostic testing are vital. They help identify risks for Down syndrome and other conditions. Knowing the difference between these tests is key for expectant parents.

The Importance of the 20-Week Anatomy Scan

As pregnancy moves along, the 20-week anatomy scan is key. It gives us important info about the baby’s growth and health. This ultrasound checks how the fetus’s organs and body parts are developing.

Purpose of Mid-Pregnancy Ultrasound

The main goal of the 20-week scan is to look at the fetus’s body in detail. We use it to find any possible birth defects or issues. It’s a big part of prenatal care, helping us spot problems early.

Key aspects evaluated during this scan include:

  • Fetal anatomy: We look at the baby’s organs and body parts.
  • Growth assessment: We check if the baby is growing right.
  • Congenital conditions: We search for any birth defects.

Standard Components of the Scan

During the 20-week scan, we check many parts of the fetus’s body. These include:

Component

Description

Head and Brain

We check the brain’s structure and look for any problems.

Heart

We do a close look at the heart’s structure.

Abdomen

We examine the abdominal organs and look for any issues.

Limbs

We check the limbs to make sure they’re growing right.

Preparation for the Examination

To make the 20-week scan go well, getting ready is important. Drinking lots of water before the scan helps us see the fetus clearly. Also, having a full bladder can make the ultrasound images better.

Talking to your healthcare provider about any worries or questions is a good idea. It helps you know what to expect and eases any concerns.

Down Syndrome Ultrasound vs Normal 20 Weeks: Key Differences

It’s important for expectant parents to know the differences between a normal 20-week ultrasound and one that might show Down syndrome. At this stage, we can spot several key signs that might point to Down syndrome.

Normal Ultrasound Findings at 20 Weeks

A normal 20-week ultrasound shows a fetus growing well and developing normally. The anatomy scan at this time gives us a detailed look at the fetus’s organs and body parts. This helps us check how they are developing.

Normal findings include seeing the fetus’s anatomy clearly, like the heart, kidneys, and limbs, without big problems. The nuchal fold thickness is also checked; it should be less than 6mm.

Detection Rate of Down Syndrome at 20 Weeks

Ultrasound at 20 weeks can spot Down syndrome in about 39% to 45% of cases. Several markers help in this assessment. A thickened nuchal fold is a common sign in the second trimester ultrasound.

Other signs at 20 weeks include a small or missing nasal bone, shorter femur length, and echogenic bowel. If these markers show up, more tests are needed to confirm Down syndrome.

Marker

Normal Finding

Potential Indicator of Down Syndrome

Nuchal Fold Thickness

<6mm

≥6mm

Nasal Bone

Present

Small or Absent

Femur Length

Expected Length

Shortened

Bowel Echogenicity

Normal

Echogenic

Major Structural Differences

At 20 weeks, an ultrasound can show major differences between a normal fetus and one with Down syndrome. These differences often include heart defects, gastrointestinal issues, and other structural problems.

“The 20-week ultrasound is a key tool for diagnosing, giving insights into fetal development and possible Down syndrome-related anomalies.”

Understanding these differences is key for giving expectant parents the best care possible during prenatal diagnosis.

Soft Markers for Down Syndrome at 20 Weeks

At the 20-week anatomy scan, doctors look for soft markers that might suggest Down syndrome. These markers are ultrasound signs that could point to chromosomal issues. But, they don’t confirm anything on their own. We consider them together to gauge the risk.

Thickened Nuchal Fold (≥6mm)

A thickened nuchal fold is a key soft marker for Down syndrome. The nuchal fold is the area at the back of the fetal neck. If it’s 6mm or more, it’s considered thickened and needs more testing. Remember, a thickened nuchal fold doesn’t mean Down syndrome but suggests more tests are needed.

Nasal Bone Abnormalities

Nasal bone issues, like its absence or underdevelopment, are linked to Down syndrome risk. The nasal bone should be visible by 20 weeks. Its absence is a big marker, but it’s not the only sign of Down syndrome.

A study in the Journal of Ultrasound in Medicine found that nasal bone absence is a strong marker for Down syndrome, with a detection rate of about 69%.

“The presence or absence of the nasal bone is an important marker that should be evaluated during the 20-week ultrasound,” says Medical Expert, a specialist in maternal-fetal medicine.

Shortened Femur Length

A shorter femur length is another soft marker for Down syndrome. The femur length is measured during the ultrasound. If it’s much shorter than expected, it might mean a higher risk. But, we must look at this marker with other signs.

Echogenic Bowel

Echogenic bowel means the bowel looks brighter than usual on the ultrasound. It can be linked to Down syndrome and other conditions. Seeing echogenic bowel means we need to check it closely and might need more tests.

In summary, these soft markers are important but not definitive for Down syndrome. We use them along with other signs to give a full risk assessment.

First Trimester Ultrasound Findings

Ultrasound findings in the first trimester are key in checking for Down syndrome risk. This period, from week 1 to 12, is vital for the fetus’s growth. Ultrasound scans during this time can show important details about the fetus’s health.

Down Syndrome Ultrasound vs Normal 12 Weeks

By 12 weeks, some signs may point to a higher Down syndrome risk. These include increased nuchal translucency and absence or hypoplasia of the nasal bone. Nuchal translucency is the fluid layer at the fetus’s neck’s back. If it’s too thick, it could mean a higher risk of Down syndrome and other issues.

The nasal bone’s size or absence is another sign. Studies show that fetuses with Down syndrome often have a smaller or missing nasal bone. We look at these signs to gauge risk, not to confirm Down syndrome.

Down Syndrome Ultrasound vs Normal 10 Weeks

Some signs can be checked as early as 10 weeks, not just 12 weeks. Nuchal translucency can be measured from 11 to 14 weeks. But, some studies say it can be checked at 10 weeks in some cases. Signs like ductus venosus flow abnormalities and tricuspid regurgitation also hint at a higher risk.

Seeing these signs doesn’t mean Down syndrome is confirmed. It just means more tests are needed. We advise parents to get a full assessment and counseling to understand these findings.

Important markers for Down syndrome in the first trimester include:

  • Increased nuchal translucency
  • Absence or hypoplasia of the nasal bone
  • Ductus venosus flow abnormalities
  • Tricuspid regurgitation

These signs are vital for spotting Down syndrome risk and guiding further tests.

Additional Ultrasound Markers

There are more ultrasound signs that might point to Down syndrome. These signs, while not sure on their own, help when looking at the whole risk picture.

Renal Pyelectasis (>4mm)

Renal pyelectasis means the kidney’s pelvis is wider than 4 mm. It’s linked to Down syndrome. This sign is common and might need more checking.

Cardiac Abnormalities

Some heart problems are more common in fetuses with Down syndrome. Ultrasound can spot these issues, like atrioventricular septal defect. This is a big heart defect.

  • Atrioventricular Septal Defect: A hole in the heart’s wall between chambers.
  • Other Cardiac Issues: Ultrasound can find many heart problems.

Sandal Gap Deformity

Sandal gap deformity means a big gap between the first and second toes. It might suggest Down syndrome. Though not only found in Down syndrome, it’s worth noting.

Clinodactyly

Clinodactyly is when the little finger curves. It’s linked to Down syndrome. Ultrasound can check the fetal hand for this sign.

What Happens After Detecting Markers

Seeing soft markers on an ultrasound can be scary. But knowing what happens next can make things clearer. Soft markers don’t mean for sure that a baby has Down syndrome. They just mean there might be a higher chance. It’s important to talk to doctors to understand what this means and what to do next.

Risk Assessment Calculation

When soft markers show up, the first thing is to figure out the risk. Doctors look at things like how old the mom is, her health history, and how many soft markers there are. A good risk assessment gives a clearer picture.

Calculating the risk involves:

  • Looking at the ultrasound results
  • Checking the mom’s age and health history
  • Seeing how many soft markers there are

Follow-up Testing Options

After figuring out the risk, more tests might be needed. These tests can be things like amniocentesis or CVS. These tests can tell for sure if there’s a problem, but they also have some risks.

Some tests that might be done include:

  1. Amniocentesis: This takes a sample of amniotic fluid to check for genetic issues.
  2. CVS: This takes cells from the placenta to find chromosomal problems.
  3. Detailed ultrasound: This is another ultrasound to look for more signs.

Consulting with Genetic Counselors

Genetic counselors are very important. They help parents understand their risk and what the tests mean. They offer support and advice to help families make good choices.

“Genetic counselors help families through prenatal testing and diagnosis. They give personalized advice and support.”

Making Informed Decisions

The results from risk and test assessments help families make choices about their pregnancy. They can decide to keep the pregnancy, prepare for a child with special needs, or look at other options.

Making choices means:

Decision Factors

Considerations

Continuing the Pregnancy

Understanding the possible health of the child

Preparing for a Child with Special Needs

Finding resources and support for a child with Down syndrome

By knowing what’s happening and what options they have, families can face this time with more confidence and understanding.

Conclusion

Expectant parents need to understand what ultrasound findings mean. Ultrasound results might hint at Down syndrome, but they’re not sure. To know for sure, more tests are needed.

We’ve talked about how to spot Down syndrome before a baby is born. This includes prenatal tests and the 20-week scan. We also looked at the differences in ultrasound images at 20 weeks.

Knowing these details helps parents make better choices about their pregnancy. It’s key to talk to doctors and genetic counselors for advice.

In short, learning about ultrasound results and tests helps parents feel more confident during their pregnancy.

FAQ

What is Down syndrome and how is it detected during pregnancy?

Down syndrome, also known as Trisomy 21, is a genetic disorder. It happens when there’s an extra copy of chromosome 21. Tests like ultrasound and Non-Invasive Prenatal Testing (NIPT) can find it during pregnancy.

What is the role of ultrasound in detecting Down syndrome?

Ultrasound is key in finding Down syndrome. It looks for soft markers and structural issues that might show the condition. The 20-week anatomy scan is a big ultrasound that checks the baby’s body for these signs.

What are soft markers for Down syndrome?

Soft markers are ultrasound signs that might mean a higher risk of Down syndrome. These include a thick nuchal fold, nasal bone issues, short femur length, and echogenic bowel, among others.

How accurate is the 20-week ultrasound in detecting Down syndrome?

The 20-week ultrasound can spot a lot of Down syndrome cases. If it finds soft markers or structural issues, it might mean a higher risk. This could lead to more testing.

What happens if soft markers are detected during the 20-week ultrasound?

If soft markers are found, a risk assessment is done. Then, options for more testing are talked about. This might include amniocentesis or CVS to confirm if Down syndrome is present.

Can Down syndrome be detected during the first trimester?

Yes, Down syndrome can be found early, in the first trimester. Ultrasound and NIPT can spot early signs of chromosomal issues.

What are the additional ultrasound markers that can indicate Down syndrome?

More ultrasound markers for Down syndrome include renal pyelectasis, cardiac issues, sandal gap deformity, and clinodactyly, among others.

How do I prepare for the 20-week anatomy scan?

To get ready for the 20-week anatomy scan, know what it’s for and what it checks. Talk to your healthcare provider about any worries or questions you have before the scan.

What is the difference between prenatal screening and diagnostic testing?

Prenatal screening tests, like NIPT and ultrasound, check for Down syndrome risk. But, tests like amniocentesis and CVS give a clear diagnosis.

Why is consulting with genetic counselors important after detecting markers?

Talking to genetic counselors is key after finding markers. They help with risk assessment, discuss more testing, and guide you in making informed choices about your pregnancy.


References

Down Syndrome Ultrasound vs Normal 20 Weeks https://pmc.ncbi.nlm.nih.gov/articles/PMC3984820/

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Medical Disclaimer

The content on this page is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Always consult a qualified healthcare provider regarding any medical conditions.

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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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