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İmmün Olmayan Hidrops Fetalis Olgularının Değerlendirilmesi

Yıl 2013, Cilt: 7 Sayı: 1, 1 - 5, 01.04.2013

Öz

Giriş ve Amaç: Bu çalışmada dört yıl içerisinde hastanemizde doğan bebekler içinde immün olmayan hidrops fetalis tanısı alan olguların özelliklerini değerlendirdik.Gereç ve Yöntemler: Retrospektif olarak planlanan ve etik kurul onayı alınan çalışmaya Ocak 2008 ile Aralık 2011 tarihleri arasında hastanemizde doğan, immün olmayan hidrops fetalis tanısı alan olgular dahil edildi.Bulgular: Çalışma süresince 39 olgu immün olmayan hidrops fetalis tanısı aldı. Olgulardan 22’si (%56.4) antenatal dönemde tanı almıştı ve bunların 8’inin (%20.5) nedeni prenatal dönemde saptandı. En sık saptanan bulgu tüm hastalarda görülen yaygın cilt ödemi (%100) iken, neonatal asit (%84.6) ikinci sıklıkta saptandı. Neden olarak iki olguda konjenital kalp hastalığı, iki olguda supraventriküler taşikardi, iki olguda konjenital kistik adenomatoid malformasyon, iki olguda şilotoraks, yedi olguda ikizden ikize transfüzyon sendromu, üç olguda anemi saptanırken, beş olgunun dismorfik olduğu, bir olguda kistik higromaya ve bir olguda ise intrauterin perfore mekonyum ileusuna bağlı immün olmayan hidrops fetalis geliştiği düşünüldü. Geri kalan 14 (%35.9) olguda ise neden bulunamadı. Mortalite oranı %76.9 (30/39) olup, 16’sı (%41) ilk 24 saat içinde kaybedildi.Sonuç: İmmün olmayan hidrops fetalis olgularında mortalite oranı halen çok yüksektir. Çalışmamızda antenatal dönemde en sık rastlanılan bulgular cilt ödemi ve neonatal asitti. Nedenler arasında farklı organ ve sistemlerin hastalıkları yer almaktadır. Bu yüzden tanı için çok sayıda test ve incelemenin kısa sürede yapılması gerekebilmektedir.

Kaynakça

  • Lorch SA, Mollen TJ. Nonımmune hydrops. In: Christine A. Gleason, Sherin U. Devaskar Eds. Avery’s Disease of the Newborn. 9th ed. 2012;81-7.
  • Mahony BS, Filly RA, Callen PW, Chinn DH, Golbus MS. Severe nonimmune hydrops fetalis: Sonographic evaluation. Radiology 1984;151:757-61.
  • Branch DW. Immunologic disease and fetal death. Clin Obstet Gynecol 1987;30:295-311.
  • Bellini C, Fulcheri E, Rutigliani M, Calevo MG, Boccardo F, Campisi, et al. Etiology of nonimmune hydrops fetalis: A systematic review. Am J Med Genet A 2009;149A:844-51.
  • Graves GR, Baskett TF. Nonimmune hydrops fetalis: Antenatal diagnosis and management. Am J Obstet Gynecol 1984;148: 563-65.
  • Hutchison AA, Drew JH, Yu VY, Williams ML, Fortune DW, Beischer NA. Nonimmunologic hydrops fetalis: A review of 61 cases. Obstet Gynecol 1982;59:347-52.
  • Sohan K, Carroll SG, De La Fuente S, Soothill P, Kyle P. Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment. Acta Obstet Gynecol Scand 2001;80:726-30.
  • Santo S, Mansour S, Thilaganathan B, Homfray T, Papageorghiou A, Calvert S, et al. Prenatal diagnosis of non-immune hydrops fetalis: What do we tell the parents? Prenat Diagn 2011;31: 186-95.
  • Jones D. Nonimmune fetal hydrops: Diagnosis and management. Semin Perinatol 1995;19:447-61.
  • Bullard K, Harrison M. Before the horse is out of the barn: Fetal surgery for hydrops. Semin Perinatol 1995;19:462-73.
  • Bukowski R, Saade GR. Hydrops fetalis. Clin Perinatol 2000;27:1007-31.
  • Bellini C, Boccardo F, Bonioli E, Campisi C. Lymphodynamics in the fetus and newborn. Lymphology 2006;39:110-17.
  • Galea P, Jain V, Fisk NM. Insights into the pathophysiology of twin- twin transfusion syndrome. Prenat Diagn 2005;25:777-85.
  • Van Den Wijngaard JP, Ross MG, Van Gement MJ. Twin-twin transfusion syndrome modeling. Ann N Y Acad Sci 2007;1101: 215-34.
  • Türkiye Nüfus ve Sağlık Araştırması İleri Analiz Raporu, Ankara, 2010
  • Heinonen S, Ryynänen M, Kirkinen P. Etiology and outcome of second trimester non-immunologic fetal hydrops. Acta Obstet Gynecol Scand 2000;79:15-8.

Evaluation of Cases with Nonimmune Hydrops Fetalis

Yıl 2013, Cilt: 7 Sayı: 1, 1 - 5, 01.04.2013

Öz

Objective: We evaluated the characteristics of babies with nonimmune hydrops fetalis born at our hospital during a four-year period.Material and Methods: All newborns with a prenatal or early neonatal diagnosis of nonimmune hydrops fetalis based on clinical history, physical and laboratory examination during the period between January 2008 and December 2011 were evaluated retrospectively.results: A total of 39 newborns with hydrops fetalis were included in this study. Twenty two infants (56.4%) were diagnosed in the antenatal period, and the etiological factor was evident in the prenatal period in 8 infants (20.5%). The most common finding was skin edema in all patients (100%), while neonatal ascites (84.6%) was the second most common sign. Findings related with nonimmune hydrops fetalis were as follows: congenital heart disease (2/39), arrythmia (2/39), congenital cystic adenomatoid malformation (2/39), chylothorax (2/39), cystic hygroma (1/39), twin-totwin transfusion syndrome (7/39), anemia (3/39), genetic/chromosomal abnormalities (5/39), and perforated intrauterine meconium ileus (1/39). No obvious cause was identified in 35.8% (14/39) of cases and these were classified as idiopathic. The mortality rate was 76.9%, and 16 of them (41%) died within the first 24 hours of life.conclusion: The mortality rate is still very high in nonimmune hydrops fetalis. The most common signs were skin edema and neonatal ascites in the antenatal period. Diseases of organs and systems were frequent among the causes of nonimmune hydrops fetalis. Comprehensive diagnostic testing and examinations should therefore be performed as soon as possible

Kaynakça

  • Lorch SA, Mollen TJ. Nonımmune hydrops. In: Christine A. Gleason, Sherin U. Devaskar Eds. Avery’s Disease of the Newborn. 9th ed. 2012;81-7.
  • Mahony BS, Filly RA, Callen PW, Chinn DH, Golbus MS. Severe nonimmune hydrops fetalis: Sonographic evaluation. Radiology 1984;151:757-61.
  • Branch DW. Immunologic disease and fetal death. Clin Obstet Gynecol 1987;30:295-311.
  • Bellini C, Fulcheri E, Rutigliani M, Calevo MG, Boccardo F, Campisi, et al. Etiology of nonimmune hydrops fetalis: A systematic review. Am J Med Genet A 2009;149A:844-51.
  • Graves GR, Baskett TF. Nonimmune hydrops fetalis: Antenatal diagnosis and management. Am J Obstet Gynecol 1984;148: 563-65.
  • Hutchison AA, Drew JH, Yu VY, Williams ML, Fortune DW, Beischer NA. Nonimmunologic hydrops fetalis: A review of 61 cases. Obstet Gynecol 1982;59:347-52.
  • Sohan K, Carroll SG, De La Fuente S, Soothill P, Kyle P. Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment. Acta Obstet Gynecol Scand 2001;80:726-30.
  • Santo S, Mansour S, Thilaganathan B, Homfray T, Papageorghiou A, Calvert S, et al. Prenatal diagnosis of non-immune hydrops fetalis: What do we tell the parents? Prenat Diagn 2011;31: 186-95.
  • Jones D. Nonimmune fetal hydrops: Diagnosis and management. Semin Perinatol 1995;19:447-61.
  • Bullard K, Harrison M. Before the horse is out of the barn: Fetal surgery for hydrops. Semin Perinatol 1995;19:462-73.
  • Bukowski R, Saade GR. Hydrops fetalis. Clin Perinatol 2000;27:1007-31.
  • Bellini C, Boccardo F, Bonioli E, Campisi C. Lymphodynamics in the fetus and newborn. Lymphology 2006;39:110-17.
  • Galea P, Jain V, Fisk NM. Insights into the pathophysiology of twin- twin transfusion syndrome. Prenat Diagn 2005;25:777-85.
  • Van Den Wijngaard JP, Ross MG, Van Gement MJ. Twin-twin transfusion syndrome modeling. Ann N Y Acad Sci 2007;1101: 215-34.
  • Türkiye Nüfus ve Sağlık Araştırması İleri Analiz Raporu, Ankara, 2010
  • Heinonen S, Ryynänen M, Kirkinen P. Etiology and outcome of second trimester non-immunologic fetal hydrops. Acta Obstet Gynecol Scand 2000;79:15-8.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Diğer ID JA27JH73FM
Bölüm Research Article
Yazarlar

Avidan Kizilelma Yiğit Bu kişi benim

Şerife Suna Oğuz

Uğur Dilmen Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2013
Gönderilme Tarihi 1 Nisan 2013
Yayımlandığı Sayı Yıl 2013 Cilt: 7 Sayı: 1

Kaynak Göster

Vancouver Yiğit AK, Oğuz ŞS, Dilmen U. Evaluation of Cases with Nonimmune Hydrops Fetalis. Türkiye Çocuk Hast Derg. 2013;7(1):1-5.

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