Araştırma Makalesi
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Mekonyumlu Gebeliklerde Doğum Eyleminin ve Sonuçlarının Değerlendirilmesi: Prospektif Kohort Çalışması

Yıl 2022, Cilt: 4 Sayı: 3, 121 - 127, 22.09.2022
https://doi.org/10.46969/etlikzubeyde.1153588

Öz

Amaç: Bu çalışmanın amacı, düşük riskli bir gebelikte mekonyum boyalı amniyotik sıvı için risk faktörlerini belirlemek ve mekonyum boyalı amniyotik sıvı (MBAS) varlığındaki doğumlarda doğum komplikasyonlarını ve yenidoğan sonuçlarını değerlendirmektir.
Gereç ve Yöntemler: Bu prospektif çalışma Nisan 2015-Eylül 2015 tarihleri arasında Ankara Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi’nde yapıldı. Çalışmaya 37. gebelik haftasına ulaşmış tekil gebelik ve baş pozisyonu olan 351 kadın dahil edildi. Bilinen kronik sistemik hastalıkları, gebelik komplikasyonları ve geçirilmiş uterin cerrahisi olan kadınlar çalışma dışı bırakıldı. Bu çalışmaya MBAS’lı 151 olgu ve berrak amniyotik sıvısı olan rastgele seçilmiş 200 kontrol olgusu dahil edildi. İki grubu anne yaşı, gravidite, parite, gebelik yaşı, intrapartum maternal ateş, vücut kitle indeksi (VKİ), doğum süresi, kardiyotokografik değerler, doğum şekli, neonatal sonuç ve yenidoğan yoğun bakım ünitesine yatış oranları açısından karşılaştırdık.
Bulgular: Çalışmamızda doğumda mekonyum boyanması olan yenidoğanların %2,6’sında (4/151) mekonyum aspirasyon sendromu (MAS) gelişti. MBAS grubunda gebelik yaşı, intrapartum maternal ateş ve VKİ anlamlı olarak yüksekti (p=0,003). Doğumun aktif fazının süresi (6 cm’den 10 cm’ye servikal dilatasyon) her iki grupta benzerdi ve MBAS grubunda doğumun ikinci fazının süresi daha uzundu (p=0,002). MBAS, kardiyotokografik incelemelerde, doğum komplikasyonlarında ve yenidoğan sonuçlarında artan sayıda anormal sonuçla ilişkili bulundu (p < 0,001).
Sonuç: Mekonyum boyalı amniyotik sıvı ile yapılan doğumlar artmış morbidite ile ilişkilidir; bu nedenle intrapartum muayeneler daha sık ve dikkatli yapılmalı ve olası olumsuz yenidoğan sonuçlarını azaltmak için doğum sırasında çocuk doktorları ile işbirliği içinde önlemler alınmalıdır.

Kaynakça

  • Ovalı F. Mekonyum aspirasyon sendromu. Dağoğlu T, editor. İstanbul: Nobel Tıp Kitapevi; 2000: 311-316.
  • Whitsett JA, Rice WR, Warner BB, Wert SE, Pryhuber GS. Acute respiratory disorders. In M. G. MacDonald, M. D. Mullett, & M. M. K. Seshia (eds.), Avery’s Neonatology. Pathophysiology & Management of the Newborn.6th eds. Philadelphia: Lippincott Williams & Wilkins. 2005;553-577.
  • Wiswell TE, Bent RC. Meconium staining and the meconium aspiration syndrome. Pediatr Clin North Am 1993;40(5):955-981.
  • Yurdakul Z, Turkoz HK, Bilgen H, Solakoglu S, Kavuncuoglu S, Ozek E. Placental ultrastructural changes and apoptosis in pregnancies with meconium stained amniotic fluid. Turk Patoloji Dergisi. 2012;28(2):147-199.
  • Benirschke K, Burton GJ, Baergen RN. Maternal diseases complicating pregnancy: diabetes, tumors, preeclampsia, lupus anticoagulant. Pathology of the Human Placenta 2012; 495-555.
  • Shaikh EM, Mehmood S, Shaikh MA. Neonatal outcome in meconium stained amniotic fluid-one year experience. The J Pak Med Assoc 2010 ;60(9):711-714.
  • Jiménez E, Marín ML, Martín R, et al. Is meconium from healthy newborns actually sterile? Res Microbiol 2008;159(3):187-193.
  • Sienko A, Altshuler G. Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines. Obstet Gynecol 1999;94(3):415-420.
  • Van Ierland Y, de Beaufort AJ. Why does meconium cause meconium aspiration syndrome? Current concepts of MAS pathophysiology. Early Hum Dev 2009;85(10):617-620.
  • Mahmoud EL, Benirschke K, Vaucher YE, Poitras P. Motilin levels in term neonates who have passed meconium prior to birth. J Pediatr Gastroenterol Nutr 1988;7(1):95-99.
  • Navakauskiene R, Baronaite S, Matuzevicius D, et al. Identification and Characterization of Amniotic Fluid Proteins Incident to Normal, Preeclampsia and Polyhydramnios Pregnancies. Current Proteomics 2016; 13(3): 206-217.
  • Yeh TF. Core concepts: meconium aspiration syndrome: pathogenesis and current management. NeoReviews 2010; 11(9): 503-512.
  • Siva Saranappa SB, Nair CC, Madhu GN, Srinivasa S, Manjunath MN. Clinical profile and outcome of perinatal asphyxia in a tertiary care centre. Current Pediatric Research 2015;19 (2):9 -12.
  • Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011;117(4):828-835.
  • Clausson B, Cnattingius S, Axelsson O. Outcomes of post-term births: the role of fetal growth restriction and malformations. Obstet Gynecol 1999;94(5 Pt 1):758-762.
  • Mokra D, Calkovska A. How to overcome surfactant dysfunction in meconium aspiration syndrome? Respir Physiol Neurobiol 2013 187(1):58-63.
  • Davis PJ, Shekerdemian LS. Meconium aspiration syndrome and extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 2001;84(1):F1-3.
  • Goel A, Nangia S. Meconium aspiration syndrome: challenges and solutions. Res Rep Neonatol 2017; 7(1): 19-28.
  • Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatr Clin North Am 1998;45(3):511-529.
  • Zhang J, Landy HJ, Branch DW, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010;116(6):1281-1287.
  • Fanaroff AA. Meconium aspiration syndrome: historical aspects. J Perinatol 2008;28 Suppl 3:S3-7.
  • Gouyon JB, Ribakovsky C, Ferdynus C, Quantin C, Sagot P, Gouyon B. Severe respiratory disorders in term neonates. Paediatr Perinat Epidemiol 2008;22(1):22-30.
  • Özdemir R, Akçay A, Dizdar EA, ve ark. The incidence and prognostic factors in meconium aspiration syndrome: one-center experience. Cocuk Sagligi ve Hastaliklari Dergisi 2011;54(4):211-215.
  • Osava RH, Silva FM, Vasconcellos de Oliveira SM, Tuesta EF, Amaral MC. Meconium-stained amniotic fluid and maternal and neonatal factors associated. Rev Saude Publica 2012;46(6):1023-1039.
  • Oyelese Y, Culin A, Ananth CV, Kaminsky LM, Vintzileos A, Smulian JC. Meconium-stained amniotic fluid across gestation and neonatal acid-base status. Obstet Gynecol 2006;108(2):345-349.
  • Lee KA, Mi Lee S, Jin Yang H, et al. The frequency of meconium-stained amniotic fluid increases as a function of the duration of labor. J Matern Fetal Neonatal Med 2011;24(7):880-885.
  • Romero R, Hanaoka S, Mazor M, et al. Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 1991;164(3):859-862.
  • Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011;117(4):828-835.
  • Odongo BE, Ndavi PM, Gachuno OW, Sequeira E. Cardiotocography and perinatal outcome in women with and without meconium stained liquor. East Afr Med J 2010;87(5):199-204.
  • Wong SF, Chow KM, Ho LC. The relative risk of ‘fetal distress’ in pregnancy associated with meconium-stained liquor at different gestation. J Obstet Gynaecol 2002;22(6):594-599.
  • Becker S, Solomayer E, Dogan C, Wallwiener D, Fehm T. Meconium-stained amniotic fluid perinatal outcome and obstetrical management in a low-risk suburban population. European Eur J Obstet Gynecol Reprod Biol 2007;132(1):46-50.
  • Khazardoost S, Hantoushzadeh S, Khooshideh M, Borna S. Risk factors for meconium aspiration in meconium stained amniotic fluid. J Obstet Gynaecol 2007;27(6):577-579.
  • Ziadeh SM, Sunna E. Obstetric and perinatal outcome of pregnancies with term labour and meconium-stained amniotic fluid. Arch Gynecol Obstet 2000;264(2):84-87.
  • Mundhra R, Agarwal M. Fetal outcome in meconium stained deliveries. J Clin Diagn Res 2013;7(12):2874-2876.

Deliveries with Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study

Yıl 2022, Cilt: 4 Sayı: 3, 121 - 127, 22.09.2022
https://doi.org/10.46969/etlikzubeyde.1153588

Öz

Background: The aim of this study was to determine the risk factors for meconium-stained amniotic fluid in a low-risk pregnancy and to evaluate birth complications and neonatal outcomes in deliveries with meconium-stained amniotic fluid (MSAF).
Material and Methods: This prospective study was conducted between April 2015 and September 2015 at Ankara Zekai Tahir Burak Women’s Health Education and Research Hospital. 351 women with singleton pregnancies and cephalic position who had reached 37 weeks of gestation were included in the study. Women with known chronic systemic diseases, pregnancy complications, and previous uterine surgery were excluded. 151 cases with MSAF and 200 randomly selected control cases with clear amniotic fluid were included in this study. We compared the two groups in terms of maternal age, gravidity, parity, gestational age, intrapartum maternal fever, body mass index (BMI), duration of labor, cardiotocographic values (CTG), mode of delivery, neonatal outcomes, and admission to the neonatal intensive care unit.
Results: In our study, meconium aspiration syndrome (MAS) developed in 2.6% (4/151) of neonates with meconium staining at birth. Gestational age, intrapartum maternal fever and BMI were significantly increased in the MSAF group (p=0.003). The duration of the active phase of labor (cervical dilation from 6 cm to 10 cm) was similar in both groups, and the duration of the second phase of labor was longer in the MSAF group (p=0.002). MSAF was associated with an increased number of abnormal results in cardiotocographic examinations, birth complications, and neonatal outcome (p < 0.001).
Conclusion: Deliveries with meconium-stained amniotic fluid are associated with increased morbidity; therefore, intrapartum examinations should be performed more frequently and carefully, and precautions should be taken during labor in collaboration with pediatricians to reduce potential adverse neonatal outcomes.

Kaynakça

  • Ovalı F. Mekonyum aspirasyon sendromu. Dağoğlu T, editor. İstanbul: Nobel Tıp Kitapevi; 2000: 311-316.
  • Whitsett JA, Rice WR, Warner BB, Wert SE, Pryhuber GS. Acute respiratory disorders. In M. G. MacDonald, M. D. Mullett, & M. M. K. Seshia (eds.), Avery’s Neonatology. Pathophysiology & Management of the Newborn.6th eds. Philadelphia: Lippincott Williams & Wilkins. 2005;553-577.
  • Wiswell TE, Bent RC. Meconium staining and the meconium aspiration syndrome. Pediatr Clin North Am 1993;40(5):955-981.
  • Yurdakul Z, Turkoz HK, Bilgen H, Solakoglu S, Kavuncuoglu S, Ozek E. Placental ultrastructural changes and apoptosis in pregnancies with meconium stained amniotic fluid. Turk Patoloji Dergisi. 2012;28(2):147-199.
  • Benirschke K, Burton GJ, Baergen RN. Maternal diseases complicating pregnancy: diabetes, tumors, preeclampsia, lupus anticoagulant. Pathology of the Human Placenta 2012; 495-555.
  • Shaikh EM, Mehmood S, Shaikh MA. Neonatal outcome in meconium stained amniotic fluid-one year experience. The J Pak Med Assoc 2010 ;60(9):711-714.
  • Jiménez E, Marín ML, Martín R, et al. Is meconium from healthy newborns actually sterile? Res Microbiol 2008;159(3):187-193.
  • Sienko A, Altshuler G. Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines. Obstet Gynecol 1999;94(3):415-420.
  • Van Ierland Y, de Beaufort AJ. Why does meconium cause meconium aspiration syndrome? Current concepts of MAS pathophysiology. Early Hum Dev 2009;85(10):617-620.
  • Mahmoud EL, Benirschke K, Vaucher YE, Poitras P. Motilin levels in term neonates who have passed meconium prior to birth. J Pediatr Gastroenterol Nutr 1988;7(1):95-99.
  • Navakauskiene R, Baronaite S, Matuzevicius D, et al. Identification and Characterization of Amniotic Fluid Proteins Incident to Normal, Preeclampsia and Polyhydramnios Pregnancies. Current Proteomics 2016; 13(3): 206-217.
  • Yeh TF. Core concepts: meconium aspiration syndrome: pathogenesis and current management. NeoReviews 2010; 11(9): 503-512.
  • Siva Saranappa SB, Nair CC, Madhu GN, Srinivasa S, Manjunath MN. Clinical profile and outcome of perinatal asphyxia in a tertiary care centre. Current Pediatric Research 2015;19 (2):9 -12.
  • Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011;117(4):828-835.
  • Clausson B, Cnattingius S, Axelsson O. Outcomes of post-term births: the role of fetal growth restriction and malformations. Obstet Gynecol 1999;94(5 Pt 1):758-762.
  • Mokra D, Calkovska A. How to overcome surfactant dysfunction in meconium aspiration syndrome? Respir Physiol Neurobiol 2013 187(1):58-63.
  • Davis PJ, Shekerdemian LS. Meconium aspiration syndrome and extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 2001;84(1):F1-3.
  • Goel A, Nangia S. Meconium aspiration syndrome: challenges and solutions. Res Rep Neonatol 2017; 7(1): 19-28.
  • Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatr Clin North Am 1998;45(3):511-529.
  • Zhang J, Landy HJ, Branch DW, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010;116(6):1281-1287.
  • Fanaroff AA. Meconium aspiration syndrome: historical aspects. J Perinatol 2008;28 Suppl 3:S3-7.
  • Gouyon JB, Ribakovsky C, Ferdynus C, Quantin C, Sagot P, Gouyon B. Severe respiratory disorders in term neonates. Paediatr Perinat Epidemiol 2008;22(1):22-30.
  • Özdemir R, Akçay A, Dizdar EA, ve ark. The incidence and prognostic factors in meconium aspiration syndrome: one-center experience. Cocuk Sagligi ve Hastaliklari Dergisi 2011;54(4):211-215.
  • Osava RH, Silva FM, Vasconcellos de Oliveira SM, Tuesta EF, Amaral MC. Meconium-stained amniotic fluid and maternal and neonatal factors associated. Rev Saude Publica 2012;46(6):1023-1039.
  • Oyelese Y, Culin A, Ananth CV, Kaminsky LM, Vintzileos A, Smulian JC. Meconium-stained amniotic fluid across gestation and neonatal acid-base status. Obstet Gynecol 2006;108(2):345-349.
  • Lee KA, Mi Lee S, Jin Yang H, et al. The frequency of meconium-stained amniotic fluid increases as a function of the duration of labor. J Matern Fetal Neonatal Med 2011;24(7):880-885.
  • Romero R, Hanaoka S, Mazor M, et al. Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 1991;164(3):859-862.
  • Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011;117(4):828-835.
  • Odongo BE, Ndavi PM, Gachuno OW, Sequeira E. Cardiotocography and perinatal outcome in women with and without meconium stained liquor. East Afr Med J 2010;87(5):199-204.
  • Wong SF, Chow KM, Ho LC. The relative risk of ‘fetal distress’ in pregnancy associated with meconium-stained liquor at different gestation. J Obstet Gynaecol 2002;22(6):594-599.
  • Becker S, Solomayer E, Dogan C, Wallwiener D, Fehm T. Meconium-stained amniotic fluid perinatal outcome and obstetrical management in a low-risk suburban population. European Eur J Obstet Gynecol Reprod Biol 2007;132(1):46-50.
  • Khazardoost S, Hantoushzadeh S, Khooshideh M, Borna S. Risk factors for meconium aspiration in meconium stained amniotic fluid. J Obstet Gynaecol 2007;27(6):577-579.
  • Ziadeh SM, Sunna E. Obstetric and perinatal outcome of pregnancies with term labour and meconium-stained amniotic fluid. Arch Gynecol Obstet 2000;264(2):84-87.
  • Mundhra R, Agarwal M. Fetal outcome in meconium stained deliveries. J Clin Diagn Res 2013;7(12):2874-2876.
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kadın Hastalıkları ve Doğum
Bölüm Araştırma Makalesi
Yazarlar

Fatma Ozlu Akkuş 0000-0001-8670-3169

Canan Tapkan 0000-0001-6644-7436

Müjde Can İbanoğlu 0000-0002-8413-2064

Nagihan Cengaver 0000-0002-9657-9242

Elif Gül Yapar Eyi 0000-0001-7541-9197

Yayımlanma Tarihi 22 Eylül 2022
Kabul Tarihi 23 Ağustos 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 4 Sayı: 3

Kaynak Göster

APA Ozlu Akkuş, F., Tapkan, C., İbanoğlu, M. C., Cengaver, N., vd. (2022). Deliveries with Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, 4(3), 121-127. https://doi.org/10.46969/etlikzubeyde.1153588
AMA Ozlu Akkuş F, Tapkan C, İbanoğlu MC, Cengaver N, Yapar Eyi EG. Deliveries with Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study. Türk Kadın Sağlığı ve Neonatoloji Dergisi. Eylül 2022;4(3):121-127. doi:10.46969/etlikzubeyde.1153588
Chicago Ozlu Akkuş, Fatma, Canan Tapkan, Müjde Can İbanoğlu, Nagihan Cengaver, ve Elif Gül Yapar Eyi. “Deliveries With Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi 4, sy. 3 (Eylül 2022): 121-27. https://doi.org/10.46969/etlikzubeyde.1153588.
EndNote Ozlu Akkuş F, Tapkan C, İbanoğlu MC, Cengaver N, Yapar Eyi EG (01 Eylül 2022) Deliveries with Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study. Türk Kadın Sağlığı ve Neonatoloji Dergisi 4 3 121–127.
IEEE F. Ozlu Akkuş, C. Tapkan, M. C. İbanoğlu, N. Cengaver, ve E. G. Yapar Eyi, “Deliveries with Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study”, Türk Kadın Sağlığı ve Neonatoloji Dergisi, c. 4, sy. 3, ss. 121–127, 2022, doi: 10.46969/etlikzubeyde.1153588.
ISNAD Ozlu Akkuş, Fatma vd. “Deliveries With Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study”. Türk Kadın Sağlığı ve Neonatoloji Dergisi 4/3 (Eylül 2022), 121-127. https://doi.org/10.46969/etlikzubeyde.1153588.
JAMA Ozlu Akkuş F, Tapkan C, İbanoğlu MC, Cengaver N, Yapar Eyi EG. Deliveries with Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2022;4:121–127.
MLA Ozlu Akkuş, Fatma vd. “Deliveries With Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study”. Türk Kadın Sağlığı Ve Neonatoloji Dergisi, c. 4, sy. 3, 2022, ss. 121-7, doi:10.46969/etlikzubeyde.1153588.
Vancouver Ozlu Akkuş F, Tapkan C, İbanoğlu MC, Cengaver N, Yapar Eyi EG. Deliveries with Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study. Türk Kadın Sağlığı ve Neonatoloji Dergisi. 2022;4(3):121-7.