Doğum öncesi erken membran rüptürü (PPROM) ile komplike gebeliklerde tahmini fetal ağırlığın doğruluğunun değerlendirilmesi
Öz
Amaç: Doğum öncesi erken membran rüptürü (PPROM), fetüsün ultrason ölçümlerini ve dolayısıyla amniyotik sıvı miktarında azalma nedeniyle tahmini fetal ağırlığı (EFW) etkileyebilir. Bu çalışmanın amacı PPROM ile komplike olan gebeliklerde Hadlock IV yöntemi ile hesaplanan EFW'nin doğruluğunu doğum ağırlığı ile karşılaştırarak test etmektir.
Gereç ve Yöntem: Mayıs 2018- Haziran 2020 tarihleri arasında Kayseri Eğitim ve Araştırma Hastanesi'ne erken membran rüptürü tanısıyla başvuran hastaların verilerinin retrospektif taraması yapıldı. 23+0-36+6 hafta arası tekil gebelikler ile tahmini fetal ağırlık (EFW) doğumdan önceki 2 hafta içinde ultrasonografi ile ölçülenler çalışmaya dahil edildi. EFW'nin doğruluğu, doğum ağırlığı (BW) ile EFW (abs[EFW-BWW]/BW100) arasındaki mutlak yüzde farkla belirlendi.
Bulgular: Örneklem büyüklüğü analizine göre toplam 137 hasta çalışmaya dahil edildi. Doğum ağırlığı ile EFW arasındaki ortalama fark %7,04 (0,04-44,5) idi. EFW ve BW arasındaki fark (min-maks) BMI ≥30 kg/m2 olduğunda %10,93 (0,11-34,6), anhidramnios varlığında %9,61 (0,79-34,6) idi. Bunlar istatistiksel olarak anlamlıydı; sırasıyla p=0,001 ve p=0,007. Ancak oligohidramniyoz, primiparite ve makat prezentasyon sonuçları istatistiksel olarak anlamlı değildi (p>0,05).
Sonuç: PPROM'lu hastalarda, Hadlock IV yöntemiyle ölçülen EFW, %7,04’lük bir hata payı ile tahmin edilebilmektedir. Obez kadınlarda ve anhidroamniyozda bu fark artmakta ve tahmin zorlaşmaktadır.
Anahtar Kelimeler
Doğum öncesi erken membran rüptürü Hadlock ultrasonografi Tahmini fetal ağırlık.
Kaynakça
- ACOG Practice bulletins no. 139: premature rupture of membranes. Obstetrics and Gynecology 2013;122:918–930.
- ACOG. Practice bulletin no. 160: premature rupture of membranes. Obstetrics and Gynecology 2016;127:39–51.
- Mingione MJ, Pressman EK, Woods JR. Prevention of PPROM: Current and future strategies. The Journal of Maternal-Fetal and Neonatal Medicine, December 2006;19(12):783–789.
- Mousavia AS, Hashemib N, Kashanianb M, Sheikhansaric N, Bordbard A, Parashib S. Comparison between maternal and neonatal outcome of PPROM in the cases of amniotic fluid index (AFI) of more and less than 5 cm. Journal of Obstetrıcs and Gynaecology 2018;38(5):611–615.
- Heer IM, Kümper C, Vögtle N, Müller-Egloff S, Dugas M, Strauss A. Analysis of Factors Influencing the Ultrasonic Fetal Weight Estimation. Fetal Diagn Ther 2008;23:204–210
- Karahanoglu E, Altinboga O, Akpinar F, Gultekin İB, MD, Ozdemirci S, Akyol A. The Effect of the Amniotic Fluid Index on the Accuracy of Ultrasonographic-Estimated Fetal Weight. Ultrasound Quarterly 2017;33:148–152.
- Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991;181:129–133.
- Duncan JR, Schenone C, Dorset KM, Goedecke PJ, Tobiasz AM, L. Norman M, Schenone MH. Estimated fetal weight accuracy in pregnancies with preterm prelabor rupture of membranes by the Hadlock method. The Journal of Maternal-Fetal & Neonatal Medıcıne 2020;1-6.
- Warshafsky C, Ronzoni S, Quaglietta P, Weiner E, Zaltz A, Barrett J, Aviram A. Journal of Obstetrics and Gynaecology Canada, 2020;42:693-694
- ACOG Practice Bulletin No. 33 Diagnosis and Management Obstetrıcs & Gynecology of Preeclampsia and Eclampsia. Obstetrics & Gynecology. 2002;99(1):159-167.
- Champion ML, Jauk VC, Biggio JR, Sychowski JM, Tita AT, Harper LM. Early gestational diabetes screening based on ACOG guidelines. American Journal of Perinatology. 2024;41(S01):641-647.
- Lopez-Jimenez F, Almahmeed W, Bays H, Cuevas A, Di Angelantonio E, le Roux C et al., Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation. European journal of preventive cardiology, 2022:29(17);2218-2237.
- Guralp O, Tuten N, Tuten A, Gezer A. Factors Indicating the Accuracy of Fetal Weight Estimation in Preterm Newborns with Normal Amniotic Fluid Volume. Gynecol Obstet Reprod Med 2019;25(0):000-000
- Joanna Dakwar Shaheena, Reli Hershkovitz, Salvatore Andrea Mastroliac, Ron Charach, Ron Esheld, Dan Tirosh et al., Estimation of fetal weight using Hadlock's formulas: Is head circumference an essential parameter? European Journal of Obstetrics & Gynecology and Reproductive Biology 2019;243:87-92.
- Monier I, Ego A, Benachi A, Ancel P-Y, Goffinet F, Zeitlin J, et al., Comparison of the Hadlock and INTERGROWTH formulas for calculating estimated fetal weight in a preterm population in France. Am J Obstet Gynecol 2018;219(476):1-12.
- Aviram A, Warshafsky C, Ronzoni S, Quaglietta P, Zaltz A, Barrett J. Comparison of sonographic fetal weight estimation formulas in patients with preterm premature rupture of membranes. AJOG 2020;467
- Warshafsky C, Ronzoni S, Quaglietta P, Weiner E, Melamed N, Zaltz A, et al., Accuracy of Hadlock IV and fetal weight estimation in preterm premature rupture of membranes. Journal of Obstetrics and Gynaecology Canada 2020;42(5):694.
- Esin S, Hayran M, Tohma YA, et al. Estimation of fetal weight by ultrasonography after preterm prematüre rupture of membranes: comparison of different formulas. J Perinat Med. 2017;45(2):253–266.
- Ben-Haroush A, Yogev Y, Bar J, et al. Accuracy of sonographically estimated fetal weight in 840 women with different pregnancy complications prior to induction of labor. Ultrasound Obstet Gynecol. 2004;23(2):172– 176.
- Blitz MJ, Stork LB, Augustine S, Greenberg M, Sison CP, Rochelson B. Do maternal body mass index and amniotic fluid index affect the accuracy of sonographic estimation of fetal weight near delivery? American Journal of Obstetrics & Gynecology 2017;165.
Evaluation of the accuracy of estimated fetal weight in pregnancies complicated by premature prelabour rupture of membranes (PPROM)
Öz
Aim: Premature prelabour rupture of membranes (PPROM) can affect ultrasound measurements of the fetus and therefore, estimated fetal weight (EFW) as there is a reduced amount of amniotic fluid. The aim of this study was to test the accuracy of EFW calculated with the Hadlock IV method in pregnancies complicated by PPROM by comparisons with birthweight.
Materials and Methods: A retrospective screening was made of the data of patients admitted with a diagnosis of early membrane rupture to Kayseri Training and Research Hospital between May 2018 and June 2020. Singleton pregnancies between 23+0-36+6 weeks with estimated fetal weight (EFW) measured by ultrasonography within 2 weeks before delivery was included in the study. The accuracy of the EFW was determined by the absolute percent difference between BW and EFW (abs[EFW-BWW]/BW100).
Results: A total of 137 patients were included in the study according to the sample size analysis. The mean difference between birthweight and EFW was 7,04% (0,04-44,5). The difference (min-max) between EFW and BW was 10,93% (0,11-34,6) when BMI was ≥30 kg/m2 and 9,61% (0,79-34,6) in the presence of anhydramnios. And these were statistically significant, p=0,001 and p=0,007 respectively. However, the results for oligohydramnios, primiparity and breech presentation were not statistically significant (p>0,05).
Conclusion: In patients with PPROM, EFW measured by the Hadlock IV method can be estimated with a margin of error of 7,04%. This difference increases in obese women and anhydramnios and prediction becomes difficult.
Anahtar Kelimeler
Premature prelabour rupture of membranes Hadlock ultrasonography Estimated fetal weight.
Kaynakça
- ACOG Practice bulletins no. 139: premature rupture of membranes. Obstetrics and Gynecology 2013;122:918–930.
- ACOG. Practice bulletin no. 160: premature rupture of membranes. Obstetrics and Gynecology 2016;127:39–51.
- Mingione MJ, Pressman EK, Woods JR. Prevention of PPROM: Current and future strategies. The Journal of Maternal-Fetal and Neonatal Medicine, December 2006;19(12):783–789.
- Mousavia AS, Hashemib N, Kashanianb M, Sheikhansaric N, Bordbard A, Parashib S. Comparison between maternal and neonatal outcome of PPROM in the cases of amniotic fluid index (AFI) of more and less than 5 cm. Journal of Obstetrıcs and Gynaecology 2018;38(5):611–615.
- Heer IM, Kümper C, Vögtle N, Müller-Egloff S, Dugas M, Strauss A. Analysis of Factors Influencing the Ultrasonic Fetal Weight Estimation. Fetal Diagn Ther 2008;23:204–210
- Karahanoglu E, Altinboga O, Akpinar F, Gultekin İB, MD, Ozdemirci S, Akyol A. The Effect of the Amniotic Fluid Index on the Accuracy of Ultrasonographic-Estimated Fetal Weight. Ultrasound Quarterly 2017;33:148–152.
- Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991;181:129–133.
- Duncan JR, Schenone C, Dorset KM, Goedecke PJ, Tobiasz AM, L. Norman M, Schenone MH. Estimated fetal weight accuracy in pregnancies with preterm prelabor rupture of membranes by the Hadlock method. The Journal of Maternal-Fetal & Neonatal Medıcıne 2020;1-6.
- Warshafsky C, Ronzoni S, Quaglietta P, Weiner E, Zaltz A, Barrett J, Aviram A. Journal of Obstetrics and Gynaecology Canada, 2020;42:693-694
- ACOG Practice Bulletin No. 33 Diagnosis and Management Obstetrıcs & Gynecology of Preeclampsia and Eclampsia. Obstetrics & Gynecology. 2002;99(1):159-167.
- Champion ML, Jauk VC, Biggio JR, Sychowski JM, Tita AT, Harper LM. Early gestational diabetes screening based on ACOG guidelines. American Journal of Perinatology. 2024;41(S01):641-647.
- Lopez-Jimenez F, Almahmeed W, Bays H, Cuevas A, Di Angelantonio E, le Roux C et al., Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation. European journal of preventive cardiology, 2022:29(17);2218-2237.
- Guralp O, Tuten N, Tuten A, Gezer A. Factors Indicating the Accuracy of Fetal Weight Estimation in Preterm Newborns with Normal Amniotic Fluid Volume. Gynecol Obstet Reprod Med 2019;25(0):000-000
- Joanna Dakwar Shaheena, Reli Hershkovitz, Salvatore Andrea Mastroliac, Ron Charach, Ron Esheld, Dan Tirosh et al., Estimation of fetal weight using Hadlock's formulas: Is head circumference an essential parameter? European Journal of Obstetrics & Gynecology and Reproductive Biology 2019;243:87-92.
- Monier I, Ego A, Benachi A, Ancel P-Y, Goffinet F, Zeitlin J, et al., Comparison of the Hadlock and INTERGROWTH formulas for calculating estimated fetal weight in a preterm population in France. Am J Obstet Gynecol 2018;219(476):1-12.
- Aviram A, Warshafsky C, Ronzoni S, Quaglietta P, Zaltz A, Barrett J. Comparison of sonographic fetal weight estimation formulas in patients with preterm premature rupture of membranes. AJOG 2020;467
- Warshafsky C, Ronzoni S, Quaglietta P, Weiner E, Melamed N, Zaltz A, et al., Accuracy of Hadlock IV and fetal weight estimation in preterm premature rupture of membranes. Journal of Obstetrics and Gynaecology Canada 2020;42(5):694.
- Esin S, Hayran M, Tohma YA, et al. Estimation of fetal weight by ultrasonography after preterm prematüre rupture of membranes: comparison of different formulas. J Perinat Med. 2017;45(2):253–266.
- Ben-Haroush A, Yogev Y, Bar J, et al. Accuracy of sonographically estimated fetal weight in 840 women with different pregnancy complications prior to induction of labor. Ultrasound Obstet Gynecol. 2004;23(2):172– 176.
- Blitz MJ, Stork LB, Augustine S, Greenberg M, Sison CP, Rochelson B. Do maternal body mass index and amniotic fluid index affect the accuracy of sonographic estimation of fetal weight near delivery? American Journal of Obstetrics & Gynecology 2017;165.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri (Diğer) |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Mart 2025 |
| Gönderilme Tarihi | 11 Temmuz 2024 |
| Kabul Tarihi | 12 Kasım 2024 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 64 Sayı: 1 |
