Öz
Amaç: Fetal viabilite öncesinde membran rüptürü meydana gelen olguların maternal ve perinatal sonuçlarını değerlendirmektir.
Gereç ve yöntem: Çalışmaya Mart 2020 ile Mart 2022 tarihleri arasında, gebelik haftası 14+0 ile 22+0 arasında olan ve membran rüptürü tanısı konulan gebeler dahil edildi. Olguların maternal ve perinatal sonuçları gebeliğin yönetim şekline göre demografik ve klinik özellikler açısından karşılaştırıldı.
Bulgular: Çalışmaya 42 olgu dahil edildi. Bu 42 olgudan 12/42 (%28.6) tanesi gebeliğinin terminasyonunu isterken, 30/42 (%71.4 ) olgu bekleme yönetimini tercih etmiştir. Bekleme yönetimini tercih eden 30 olgudan 19’unda spontan düşük meydana gelirken, 11 olguda canlı doğum gerçekleşmiştir. Yenidoğan döneminde altı bebek öldü ve genel neonatal sağ kalım % 45.5 (5/11) idi. Bekleme yönetimi ile spontan düşük olguları karşılaştırıldığında membran rüptürün meydana geldiği gebelik haftası (p>0.001), spontan düşük/doğumun gerçekleştiği gebelik haftası (p>0.001) ve latent süresi (p>0.001) açısından anlamlı fark saptandı.
Sonuç: Viabilite öncesi gebeliklerde meydana gelen membran rüptürü, hastaları ve klinisyenleri, bekleme yönetimini seçme veya gebeliği sonlandırma konusunda zorlu bir karar verme süreci ile karşı karşıya bırakır. Bekleme yönetimini tercih eden olgulardaki nihai amaç olan neonatal sağkalım oranları ise çok düşüktür.
Anahtar Kelimeler
Erken membran rüptürü erken doğum viabilite öncesi maternal sonuçlar
Kaynakça
- 1. Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32:411-28
- 2. Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol 2009; 201:230-40
- 3. Linehan LA, Walsh J, Morris A, Kenny L, O'Donoghue K, Dempsey E, et al. Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study. BMC Pregnancy Childbirth. 2016;29;16:25.
- 4. Obstetric care consensus No. 6 summary: periviable birth. Obstet Gynecol. 2017;130(4):926–28.
- 5. Azria E, Anselem O, Schmitz T, Tsatsaris V, Senat MV, Goffinet F. Comparison of perinatal outcome after pre-viable preterm prelabour rupture of membranes in two centres with different rates of termination of pregnancy. BJOG. 2012 ;119(4):449-57.
- 6. Kiver V, Boos V, Thomas A, Henrich W, Weichert A. Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation. J Perinat Med. 2018 26;46(5):555-65.
- 7. Falk SJ, Campbell LJ, Lee-Parritz A, Cohen AP, Ecker J, Wilkins-Haug L,, et al.Expectant management in spontaneous preterm premature rupture of membranes between 14 and 24 weeks' gestation. J Perinatol. 2004;24(10):611-6.
- 8. Hadi HA, Hodson CA, Strickland D. Premature rupture of the membranes between 20 and 25 weeks' gestation: role of amniotic fluid volume in perinatal outcome. Am J Obstet Gynecol. 1994;170(4):1139-44.
- 9. Farooqi A, Holmgren PA, Engberg S, Serenius F. Survival and 2-year outcome with expectant management of second-trimester rupture of membranes. Obstet Gynecol. 1998 ;92(6):895-901.
- 10. Holmgren PA, Olofsson JI. Preterm premature rupture of membranes and the associated risk for placental abruption. Inverse correlation to gestational length. Acta Obstet Gynecol Scand. 1997;76(8):743-7.
- 11. Kibel M, Asztalos E, Barrett J, Dunn MS, Tward C, Pittini A, Melamed N. Outcomes of Pregnancies Complicated by Preterm Premature Rupture of Membranes Between 20 and 24 Weeks of Gestation. Obstet Gynecol. 2016;128(2):313-20
Öz
Aim: To evaluate the maternal and perinatal outcomes of cases with rupture of membranes before fetal viability.
Materials and Methods: Between March 2020 and March 2022, pregnant women with a gestational age between 14+0 and 22+0, who diagnosed with rupture of membranes were included in the study. Maternal and perinatal outcomes of the cases were compared in terms of demographic and clinical characteristics according to the management type of pregnancy.
Results: 42 cases were included in the study. 12/42 (28.6%) of these cases have wanted the termination of their pregnancy, 30/42 (71.4%) cases have preferred the expectant management. Spontaneous abortion occurred in 19 of 30 cases who preferred the expectant management, while live birth accured in 11 cases. Six infants died during the neonatal period and overall neonatal survival was 45.5 %(5/11). When expectant management and miscarriage cases were compared, there was a statistically significant difference for the gestational week at membrane rupture occurred (p>0.001), gestational week at spontaneous abortion/delivery occurred (p>0.001) and latency period(p>0.001).
Conclusion: Rupture of membranes in pre-viable pregnancies presents patients and clinicians with a difficult decision-making process to choose between expectant management or termination of pregnancy. The neonatal survival rate, which is the ultimate goal in patients who prefer expectant management, is very low.
Anahtar Kelimeler
premature rupture of membrane preterm birth previable maternal outcomes
Kaynakça
- 1. Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32:411-28
- 2. Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol 2009; 201:230-40
- 3. Linehan LA, Walsh J, Morris A, Kenny L, O'Donoghue K, Dempsey E, et al. Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study. BMC Pregnancy Childbirth. 2016;29;16:25.
- 4. Obstetric care consensus No. 6 summary: periviable birth. Obstet Gynecol. 2017;130(4):926–28.
- 5. Azria E, Anselem O, Schmitz T, Tsatsaris V, Senat MV, Goffinet F. Comparison of perinatal outcome after pre-viable preterm prelabour rupture of membranes in two centres with different rates of termination of pregnancy. BJOG. 2012 ;119(4):449-57.
- 6. Kiver V, Boos V, Thomas A, Henrich W, Weichert A. Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation. J Perinat Med. 2018 26;46(5):555-65.
- 7. Falk SJ, Campbell LJ, Lee-Parritz A, Cohen AP, Ecker J, Wilkins-Haug L,, et al.Expectant management in spontaneous preterm premature rupture of membranes between 14 and 24 weeks' gestation. J Perinatol. 2004;24(10):611-6.
- 8. Hadi HA, Hodson CA, Strickland D. Premature rupture of the membranes between 20 and 25 weeks' gestation: role of amniotic fluid volume in perinatal outcome. Am J Obstet Gynecol. 1994;170(4):1139-44.
- 9. Farooqi A, Holmgren PA, Engberg S, Serenius F. Survival and 2-year outcome with expectant management of second-trimester rupture of membranes. Obstet Gynecol. 1998 ;92(6):895-901.
- 10. Holmgren PA, Olofsson JI. Preterm premature rupture of membranes and the associated risk for placental abruption. Inverse correlation to gestational length. Acta Obstet Gynecol Scand. 1997;76(8):743-7.
- 11. Kibel M, Asztalos E, Barrett J, Dunn MS, Tward C, Pittini A, Melamed N. Outcomes of Pregnancies Complicated by Preterm Premature Rupture of Membranes Between 20 and 24 Weeks of Gestation. Obstet Gynecol. 2016;128(2):313-20
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Kadın Hastalıkları ve Doğum |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Haziran 2023 |
| Gönderilme Tarihi | 4 Temmuz 2022 |
| Yayımlandığı Sayı | Yıl 2023Cilt: 62 Sayı: 2 |
