Öz
Amaç: Çalışmanın amacı, 41 hafta ve üzeri komplike olmayan geç-term ve post-term gebeliklerde fetal Doppler akım özelliklerini karşılaştırmak ve bunların doğum sonrası sonuçlara etkisini değerlendirmektir.
Gereç ve Yöntem: Ümraniye Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Polikliniği’ne başvuran düşük risk grubundaki toplam 98 geç-term ve post-term tekiz gebe çalışma grubuna alındı. Tüm gebelerin gebelik haftası, son adet tarihi ve erken dönem ultrasonografi verileri ile teyit edilerek hesaplandı. Hastalara sonografik değerlendirme ile tahmini fetal kilo, amniyotik sıvı hacmi, biyofizik profil ve Doppler (fetal umbilikal arter, orta serebral arter ve maternal uterin arter) incelemeleri yapıldı. Orta serebral ve umbilikal arterlerde pulsatilite ve rezistans indeksleri ile serebroplasental oran Doppler ultrasonografi ile günlük olarak değerlendirildi. Bu gebelerin doğum şekli, yenidoğan doğum kilosu, doğumda mekonyumlu amniotik sıvı varlığı, NST’de fetal distres bulgusu varlığı, yenidoğan 5. dakika Apgar skoru, fetal distres varlığında kordon kan gazı pH değeri ve yenidoğan yoğun bakım ünitesi ihtiyacı olup olmadığı kayıt altına alındı.
Bulgular: Her iki grubun ortalama uterin arter ve ortalama umbilikal arter pulsatilite indeksleri ile orta serebral arter rezistans indeksi değerleri arasında fark gösterilememiştir. Post-term grupta ortalama umbilikal arter rezistans indeksi ve orta serebral arter pulsatilite indeksi değerleri anlamlı olarak daha düşük bulunmuştur. Geç-term grupta serebroplasental oran daha düşük olsa da bu farklılık istatistiksel olarak anlamlı değildir. Her iki grupta, bebeklerin yeni doğan yoğun bakım ünitesine yatma oranları arasında anlamlı bir fark saptanmadı.
Sonuç: Anormal ve normal serebroplasental oran sonucuna göre yenidoğanın iyilik hali ve yoğun bakım ünitesinde yatma ihtiyacı açısından anlamlı ilişki saptanmamasına rağmen daha geniş serili çalışma gruplarına ihtiyaç olduğu düşünülmektedir
Anahtar Kelimeler
Kaynakça
- ACOG Committee Opinion No: 579. Definition of term pregnancy. Obstet Gynecol 2013; 122 (5): 1139-40.
- Cheng YW, Nicholson JM, Nakagawa S, Bruckner TA, Washington AE, Caughey AB. Perinatal outcomes in low-risk term pregnancies: do they differ by week of gestation? Am J Obstet Gynecol 2008; 199 (4): 370.e1-7.
- MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep 2009; 57 (8): 1-19.
- Moster D, Wilcox AJ, Vollset SE, Markestad T, Lie RT. Cerebral palsy among term and post term births. JAMA 2010; 304 (9): 976-82.
- Bhide A, Badade A, Khatal K. Assessment of reproducibility and repeatability of cerebro-placental ratio. Eur J Obstet Reprod Biol 2019; 235:106-9.
- Alfirevic Z, Stampalija T, Dowswell T. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev 2017; 6: CD007529.
- Khalil A, Morales-Rosello J, Khan N, et al. Is cerebroplacental ratio a marker of impaired fetal growth velocity and adverse pregnancy outcome? Am J Obstet Gynecol 2017; 216 (6): 606.e1-10.
- Dall'Asta A, Ghi T, Rizzo G, et al. Cerebroplacental ratio assessment in early labor in uncomplicated term pregnancy and prediction of adverse perinatal outcome: prospective multicenter study. Ultrasound Obstet Gynecol 2019; 53 (4): 481-7.
- Morales-Rosello J, Khalil A, Morlando M, Bhide A, Papageorghiou A, Thilaganathan B. Poor neonatal acid-base status in term fetuses with low cerebroplacental ratio. Ultrasound Obstet Gynecol 2015; 45 (2): 156-61.
- Khalil A.A, Morales-Rosello J, Morlando M, et al. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am J Obstet Gynecol 2015; 213: 54.e1-10.
- Oz AU, Holub B, Mendilcioglu I, Mari G, Bahado-Singh RO. Renal artery Doppler investigation of the etiology of oligohydramnios in post term pregnancy. Obstet Gynecol 2002; 100 (4): 715-8.
- Lam H, Leung WC, Lee CP, Lao TT. The use of fetal Doppler cerebroplacental blood flow and amniotic fluid volume measurement in the surveillance of postdated pregnancies. Acta Obstet Gynecol Scand 2005 Sep;84 (9): 844-8.
- Lebovitz O, Barzilay E, Mazaki-Tovi S, Gat I, Achiron R, Gilboa Y. The clinical value of maternal and fetal Doppler parameters in low-risk postdates pregnancies - a prospective study. J Matern Fetal Neonatal Med 2018 Nov; 31 (21): 2893-7.
- El-Sokkary M, Omran M, Ahmed H. Ratio of middle cerebral artery/umbilical artery Doppler velocimetry and status of newborn in postterm pregnancy. J Am Sci 2011; 7 (4): 542–9.
- D'Antonio F, Patel D, Chandrasekharan N, Thilaganathan B, Bhide A. Role of cerebroplacental ratio for fetal assessment in prolonged pregnancy. Ultrasound Obstet Gynecol 2013; 42 (2): 196-200.
- Kauppinen T, Kantomaa T, Tekay A, Mäkikallio K. Placental and fetal hemodynamics in prolonged pregnancies. Prenat Diagn 2016; 36 (7): 622-7.
Öz
Aim: The aim of this study was to compare fetal Doppler flow characteristics in uncomplicated late-term and post-term pregnancies over 41 weeks and to evaluate their effect on postpartum outcomes.
Materials and Methods: A total of 98 late-term and post-term singleton pregnant women in the low risk group who were admitted to the Umraniye Education and Research Hospital Obstetrics and Gynecology Polyclinic were included in the study group. The gestational week of all pregnant women was calculated by confirming their last menstrual period and early period ultrasonography data. Estimated fetal weight, amniotic fluid index, biophysical profile and Doppler examinations (fetal umbilical artery, middle cerebral artery and maternal uterine artery) were performed by sonographic evaluation.
The pulsatility and resistance indices of the middle cerebral and umbilical arteries and cerebroplacental ratio were evaluated daily by Doppler ultrasonography. Delivery type, birth weight, amniotic fluid with meconium at birth, presence of fetal distress finding in NST, 5th minute Apgar score, cord blood pH value in presence of fetal distress and neonatal intensive care requirement of newborns were recorded.
Results: There was no difference between the mean values of uterine artery pulsatility index, umbilical artery pulsatility index and middle cerebral artery resistance index in both groups. In the post-term group, the mean umbilical artery resistance index and middle cerebral artery pulsatility index values were significantly lower. Although cerebroplacental ratio was lower in the late term group, this difference was not statistically significant. In both groups, no significant difference was found between the rate of hospitalization in the intensive care unit of newborns.
Conclusion: Although there is no significant relationship between abnormal and normal cerebroplacental ratio results in terms of the well-being of the newborn and need for hospitalization in the intensive care unit, larger series of study groups are needed.
Anahtar Kelimeler
Cerebroplacental ratio Middle cerebral artery Umbilical artery
Kaynakça
- ACOG Committee Opinion No: 579. Definition of term pregnancy. Obstet Gynecol 2013; 122 (5): 1139-40.
- Cheng YW, Nicholson JM, Nakagawa S, Bruckner TA, Washington AE, Caughey AB. Perinatal outcomes in low-risk term pregnancies: do they differ by week of gestation? Am J Obstet Gynecol 2008; 199 (4): 370.e1-7.
- MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep 2009; 57 (8): 1-19.
- Moster D, Wilcox AJ, Vollset SE, Markestad T, Lie RT. Cerebral palsy among term and post term births. JAMA 2010; 304 (9): 976-82.
- Bhide A, Badade A, Khatal K. Assessment of reproducibility and repeatability of cerebro-placental ratio. Eur J Obstet Reprod Biol 2019; 235:106-9.
- Alfirevic Z, Stampalija T, Dowswell T. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev 2017; 6: CD007529.
- Khalil A, Morales-Rosello J, Khan N, et al. Is cerebroplacental ratio a marker of impaired fetal growth velocity and adverse pregnancy outcome? Am J Obstet Gynecol 2017; 216 (6): 606.e1-10.
- Dall'Asta A, Ghi T, Rizzo G, et al. Cerebroplacental ratio assessment in early labor in uncomplicated term pregnancy and prediction of adverse perinatal outcome: prospective multicenter study. Ultrasound Obstet Gynecol 2019; 53 (4): 481-7.
- Morales-Rosello J, Khalil A, Morlando M, Bhide A, Papageorghiou A, Thilaganathan B. Poor neonatal acid-base status in term fetuses with low cerebroplacental ratio. Ultrasound Obstet Gynecol 2015; 45 (2): 156-61.
- Khalil A.A, Morales-Rosello J, Morlando M, et al. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am J Obstet Gynecol 2015; 213: 54.e1-10.
- Oz AU, Holub B, Mendilcioglu I, Mari G, Bahado-Singh RO. Renal artery Doppler investigation of the etiology of oligohydramnios in post term pregnancy. Obstet Gynecol 2002; 100 (4): 715-8.
- Lam H, Leung WC, Lee CP, Lao TT. The use of fetal Doppler cerebroplacental blood flow and amniotic fluid volume measurement in the surveillance of postdated pregnancies. Acta Obstet Gynecol Scand 2005 Sep;84 (9): 844-8.
- Lebovitz O, Barzilay E, Mazaki-Tovi S, Gat I, Achiron R, Gilboa Y. The clinical value of maternal and fetal Doppler parameters in low-risk postdates pregnancies - a prospective study. J Matern Fetal Neonatal Med 2018 Nov; 31 (21): 2893-7.
- El-Sokkary M, Omran M, Ahmed H. Ratio of middle cerebral artery/umbilical artery Doppler velocimetry and status of newborn in postterm pregnancy. J Am Sci 2011; 7 (4): 542–9.
- D'Antonio F, Patel D, Chandrasekharan N, Thilaganathan B, Bhide A. Role of cerebroplacental ratio for fetal assessment in prolonged pregnancy. Ultrasound Obstet Gynecol 2013; 42 (2): 196-200.
- Kauppinen T, Kantomaa T, Tekay A, Mäkikallio K. Placental and fetal hemodynamics in prolonged pregnancies. Prenat Diagn 2016; 36 (7): 622-7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2020 |
| Gönderilme Tarihi | 18 Eylül 2019 |
| Yayımlandığı Sayı | Yıl 2020 |