Case Report
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İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and hCG in First Trimester

Year 2019, Volume: 9 Issue: 4, 32 - 35, 27.12.2019

Abstract

ÖZET
Amaç: İlk trimester tarama testinin yapıldığı dönem olan 11-14. gebelik haftaları arasında gebeliği hem beslenme
hem de metabolik açıdan olumsuz etkileyen ve kilo kaybettiren şiddetli hiperemezis gravidarum (HEG)
tanısı ile takip ve tedavi edilen hastalarda, bu hastalığın test belirteçlerini etkileyip etkilemediğini araştırmak
istedik.
Gereç ve yöntemler: Retrospektif olarak bir tersiyer merkezde 11-14. gebelik haftaları arasında ilk trimester
tarama testini yaptırıp ve ciddi gebelik kusmaları olan çalışma grubuyla aynı haftalarda olup gebelik bulantısı
olmayan sağlıklı gebelerden oluşan kontrol grupları karşılaştırıldı. Fetal ense saydamlığı (NT), baş popo mesafesi
(CRL), insan koryonik gonadotropin (hCG) ve gebelik ile ilişkili plazma protein-A (PAPP-A) gibi tarama testi
belirteçleri her iki grup arasında istatistiksel olarak karşılaştırıldı.
Bulgular: Ciddi HEG’i olan toplam 108 hastaya karşılık, kontrol grubu kriterlerini karşılayan 1264 gebe değerlendirildi.
Her iki grupta yaş, testin yapıldığı gebelik haftası, vücut kitle indeksi ve gravida açısından istatistiksel
olarak anlamlı bir fark yoktu. Doğum sonuçlarına bakıldığında bebek doğum kiloları ve cinsiyetleri açısından da
benzerdi. NT, CRL, serbest ß-hCG değerleri ve hCG MoM(multiple of median) değerleri açısından her iki grup
da benzer bulundu (p = 0.844, p = 0.770, p = 0.777, p = 0.634, sırasıyla). Ciddi HEG grubunda ise hem PAPP-A
seviyeleri hem de PAPP-A MoM değerleri istatistiksel olarak anlamlı oranda kontrol grubuna göre düşüktü (p
= 0.044, p = 0.001).
Sonuç: Ciddi HEG, NT, CRL ve serbest ß-hCG üzerine önemli bir etkisi yoktur. Fakat PAPP-A değerlerini değiştirdiği
saptanmıştır. Bu nedenle ciddi HEG’lu gebelerde yapılan ilk trimester tarama testi sonuçlarının etkilenebileceği
söylenebilir. Konu ile ilgili kapsamlı araştırmalara ihtiyaç vardır.
Anahtar kelimeler: Hiperemezis gravidarum; hCG, PAPP-A; İlk trimester tarama testi
ABSTRACT
Objective: We wanted to investigate whether hyperemesis gravidarum affects first trimester screening test
markers in patients who were followed up and treated with severe hyperemesis gravidarum (HEG), which
affects pregnancy both in terms of nutritionally and metabolically.
Materials and methods: A retrospective, case control study was performed in a tertiary center. The study
group included the pregnant women who had severe pregnancy vomiting and the control group included
healthy pregnant women who did not have pregnancy vomiting. Screening test markers such as fetal nuchal
translucency, crown-rump-lenght (CRL), human chorionic gonadotropin (hCG) and pregnancy-related plasma
protein-A (PAPP-A) were compared statistically between the both groups.
Results: A total of 108 patients with severe HEG were evaluated for study group and 1264 pregnant women
who met the control group criteria were evaluated. There was no statistically significant difference for maternal
age, gestational age, body mass index and gravida in both groups. The birth results were similar in terms of
birth weight and fetal gender. Both groups were similar in terms of nuchal translucency, CRL, free ß-hCG values
and hCG MoM values (p = 0.844, p = 0.770, p = 0.777, p = 0.634, respectively). In the severe HEG group, both
PAPP-A levels and PAPP-A MoM values were statistically lower than the control group (p = 0.044, p = 0.001).
Conclusion: Severe HEG has no significant effect on fetal nuchal translucency, CRL and free ß-hCG. However,
PAPP-A values could change due to severe HEG. Therefore, it can be said that the results of first trimester
screening test performed in pregnant women with HEG may be affected. Extensive research is needed on the
subject.
Keywords: Hyperemesis gravidarum; hCG; PAPP-A; First trimester screening test

References

  • KAYNAKLAR 1. Durmuşoğlu F. Hiperemezis Gravidarum. Turkiye Klinikleri Journal of Gynecology Obstetrics-Special Topics 2010;3(1):16-19 2. Jueckstock JK, Kaestner R, Mylonas I. Managing hyperemesis gravidarum:a multimodal challenge. BMC Med 2010;15(8):46–58 3. Verberg MF, Gillott DJ, Al Fardan N, Grudzinskas JG: Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005;11:527–39 4. Sekizawa A, Sugito Y, Iwasaki M, Watanabe A, Jimbo M, Hoshi S, et al: Cell-free fetal DNA is increased in plasma of women with hyperemesis gravidarum. Clin Chem 2001, 47:2164–2165 5. Canick JA, Lambert-Messerlian GM, Palomaki GE. Comparison of serum markers in first-trimester down syndrome screening. Obstet Gynecol 2006;108:1192 6. Goodwin TM. Hyperemesis gravidarum. Clin Obstet Gynecol 1998; 41:597 7. Vikanes ÅV, Stoer, NC, Magnus P, Grjibovski AM. Hyperemesis gravidarum and pregnancy outcomes in the Norwegian mother and child cohort–a cohort study. BMC pregnancy and childbirth 2013;13(1):169 8. Burton GJ, Hempstock J, Jauniaux E. Nutrition of the human fetus during the first trimester--a review. Placenta 2001;22 Suppl A:S70 9. Burton GJ, Hempstock J, Jauniaux E. Oxygen, early embryonic metabolism and free radical-mediated embryopathies. Reprod Biomed Online 2003;6:84 10. Roberts VHJ, Morgan TK, Bednarek P, Morita M, Burton GJ, Lo JO, et al. Early first trimester uteroplacental flow and the progressive disintegration of spiral artery plugs: new insights from contrast-enhanced ultrasound and tissue histopathology. Hum Reprod 2017;32:2382 11. Davis, M. Nausea and vomiting of pregnancy: an evidence-based review. The Journal of perinatal & neonatal nursing 2004;18(4):312-328. 12. Panesar NS, Li CY, Rogers MS. Are thyroid hormones or hCG responsible for hyperemesis gravidarum? A matched paired study in pregnant Chinese women. Acta obstetricia et gynecologica Scandinavica 2001;80(6):519-24 13. Atmaca U, Atalay MA, Özçimen N, Sidal B, Ateş U. Investigating Maternal Serum Thyroid Hormone, Beta-Human Chorionic Gonadotropin (Beta-HCG) and Free Beta-HCG Levels in Hyperemesis Gravidarum. Erciyes Medical Journal/Erciyes Tip Dergisi, 2015;37(4):128-32 14. Tsuruta E, Tada H, Tamaki H, Kashiwai T, Asahi K, Takeoka K, et al. Pathogenic role of asialo human chorionic gonadotropin in gestational thyrotoxicosis. The Journal of Clinical Endocrinology & Metabolism 1995;80(2):350-55 15. Derbent AU, Yanik FF, Simavli S, Atasoy L, Ürün E, Kuşçu ÜE, et al. First trimester maternal serum PAPP‐A and free β‐HCG levels in hyperemesis gravidarum. Prenatal diagnosis 2011;31(5):450-53 16. Unlu BS, Energin H, Yildiz Y, Unlu E, Eyi EY. Maternal serum pregnancy-associated plasma protein-A levels in hyperemesis gravidarum: a prospective case control study. Clinical and experimental obstetrics & gynecology 2014;41(5):534-36.
Year 2019, Volume: 9 Issue: 4, 32 - 35, 27.12.2019

Abstract

References

  • KAYNAKLAR 1. Durmuşoğlu F. Hiperemezis Gravidarum. Turkiye Klinikleri Journal of Gynecology Obstetrics-Special Topics 2010;3(1):16-19 2. Jueckstock JK, Kaestner R, Mylonas I. Managing hyperemesis gravidarum:a multimodal challenge. BMC Med 2010;15(8):46–58 3. Verberg MF, Gillott DJ, Al Fardan N, Grudzinskas JG: Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005;11:527–39 4. Sekizawa A, Sugito Y, Iwasaki M, Watanabe A, Jimbo M, Hoshi S, et al: Cell-free fetal DNA is increased in plasma of women with hyperemesis gravidarum. Clin Chem 2001, 47:2164–2165 5. Canick JA, Lambert-Messerlian GM, Palomaki GE. Comparison of serum markers in first-trimester down syndrome screening. Obstet Gynecol 2006;108:1192 6. Goodwin TM. Hyperemesis gravidarum. Clin Obstet Gynecol 1998; 41:597 7. Vikanes ÅV, Stoer, NC, Magnus P, Grjibovski AM. Hyperemesis gravidarum and pregnancy outcomes in the Norwegian mother and child cohort–a cohort study. BMC pregnancy and childbirth 2013;13(1):169 8. Burton GJ, Hempstock J, Jauniaux E. Nutrition of the human fetus during the first trimester--a review. Placenta 2001;22 Suppl A:S70 9. Burton GJ, Hempstock J, Jauniaux E. Oxygen, early embryonic metabolism and free radical-mediated embryopathies. Reprod Biomed Online 2003;6:84 10. Roberts VHJ, Morgan TK, Bednarek P, Morita M, Burton GJ, Lo JO, et al. Early first trimester uteroplacental flow and the progressive disintegration of spiral artery plugs: new insights from contrast-enhanced ultrasound and tissue histopathology. Hum Reprod 2017;32:2382 11. Davis, M. Nausea and vomiting of pregnancy: an evidence-based review. The Journal of perinatal & neonatal nursing 2004;18(4):312-328. 12. Panesar NS, Li CY, Rogers MS. Are thyroid hormones or hCG responsible for hyperemesis gravidarum? A matched paired study in pregnant Chinese women. Acta obstetricia et gynecologica Scandinavica 2001;80(6):519-24 13. Atmaca U, Atalay MA, Özçimen N, Sidal B, Ateş U. Investigating Maternal Serum Thyroid Hormone, Beta-Human Chorionic Gonadotropin (Beta-HCG) and Free Beta-HCG Levels in Hyperemesis Gravidarum. Erciyes Medical Journal/Erciyes Tip Dergisi, 2015;37(4):128-32 14. Tsuruta E, Tada H, Tamaki H, Kashiwai T, Asahi K, Takeoka K, et al. Pathogenic role of asialo human chorionic gonadotropin in gestational thyrotoxicosis. The Journal of Clinical Endocrinology & Metabolism 1995;80(2):350-55 15. Derbent AU, Yanik FF, Simavli S, Atasoy L, Ürün E, Kuşçu ÜE, et al. First trimester maternal serum PAPP‐A and free β‐HCG levels in hyperemesis gravidarum. Prenatal diagnosis 2011;31(5):450-53 16. Unlu BS, Energin H, Yildiz Y, Unlu E, Eyi EY. Maternal serum pregnancy-associated plasma protein-A levels in hyperemesis gravidarum: a prospective case control study. Clinical and experimental obstetrics & gynecology 2014;41(5):534-36.
There are 1 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Case Report
Authors

Yusuf Madendağ

İlknur Çöl Madendağ

Mefkure Eraslan Şahin This is me

Erdem Şahin This is me

Gökhan Açmaz This is me

Publication Date December 27, 2019
Published in Issue Year 2019 Volume: 9 Issue: 4

Cite

APA Madendağ, Y., Çöl Madendağ, İ., Eraslan Şahin, M., Şahin, E., et al. (2019). İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and hCG in First Trimester. Bozok Tıp Dergisi, 9(4), 32-35.
AMA Madendağ Y, Çöl Madendağ İ, Eraslan Şahin M, Şahin E, Açmaz G. İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and hCG in First Trimester. Bozok Tıp Dergisi. December 2019;9(4):32-35.
Chicago Madendağ, Yusuf, İlknur Çöl Madendağ, Mefkure Eraslan Şahin, Erdem Şahin, and Gökhan Açmaz. “İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and HCG in First Trimester”. Bozok Tıp Dergisi 9, no. 4 (December 2019): 32-35.
EndNote Madendağ Y, Çöl Madendağ İ, Eraslan Şahin M, Şahin E, Açmaz G (December 1, 2019) İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and hCG in First Trimester. Bozok Tıp Dergisi 9 4 32–35.
IEEE Y. Madendağ, İ. Çöl Madendağ, M. Eraslan Şahin, E. Şahin, and G. Açmaz, “İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and hCG in First Trimester”, Bozok Tıp Dergisi, vol. 9, no. 4, pp. 32–35, 2019.
ISNAD Madendağ, Yusuf et al. “İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and HCG in First Trimester”. Bozok Tıp Dergisi 9/4 (December 2019), 32-35.
JAMA Madendağ Y, Çöl Madendağ İ, Eraslan Şahin M, Şahin E, Açmaz G. İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and hCG in First Trimester. Bozok Tıp Dergisi. 2019;9:32–35.
MLA Madendağ, Yusuf et al. “İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and HCG in First Trimester”. Bozok Tıp Dergisi, vol. 9, no. 4, 2019, pp. 32-35.
Vancouver Madendağ Y, Çöl Madendağ İ, Eraslan Şahin M, Şahin E, Açmaz G. İLK TRİMESTERDE CİDDİ HİPEREMEZİS GRAVİDARUMUN PAPP-A VE HCG ÜZERİNE ETKİSİ Effect of Severe Hyperemesis Gravidarum on PAPP-A and hCG in First Trimester. Bozok Tıp Dergisi. 2019;9(4):32-5.
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