Acil Serklaj Başarısını Öngörmek için Preoperatif Amniyotik Sıvı Örneklerinde 16S rRNA-Spesifik PCR Kullanımı

Year 2025, Volume: 6 Issue: 1, 28 - 35, 15.03.2025

Hayal Uzelli Şimşek , Murat Kasap , Gülden Sönmez , Şeyda Çalışkan , Aydın Çorakçı , Eray Çalışkan

Abstract

Giriş: Servikal yetmezlik ve prolabe amniyon membranı varlığında acil serklajın başarısı tartışma konusudur. Teoriler, mikrobiyomun serviksin yapısal bütünlüğünü etkilemede önemli bir rol oynayabileceğini öne sürmektedir. Bu nedenle, serklaj operasyonundan önce mikrobiyom durumunun anlaşılması, prosedürün başarı oranını tahmin etmede değerli olabilir. Bu çalışma, 16S rRNA türlerinin polimeraz zincir reaksiyonu (PCR) tespiti yoluyla amniyon sıvısında mikrobiyal organizmaların varlığını incelemeyi ve orta trimester acil serklaj vakalarında perinatal sonuçlarla korelasyonunu değerlendirmeyi amaçlamaktadır.

Yöntemler: Servikal yetmezlik nedeniyle amniodrenaj ve acil serklaj planlanan 19 hasta serklaj grubunu oluşturdu. Kontrol grubu, rutinde yapılan perinatal testlerde risk saptanması üzerine amniyosentez yapılması planlanan 56 hastadan oluşturuldu.

Bulgular: Tüm kontrol hastalarında PCR negatifti, serklaj grubundaki dokuz hastanın ise PCR sonucu pozitif idi (p<0,001). PCR-pozitif 5 hastada koryoamniyonit tespit edilirken PCR-negatif hastalarda tespit edilmedi (p<0,001). PCR-pozitif hastalar arasında üç yenidoğanda sepsis gelişti, ancak PCR-negatif hastaların yenidoğanlarında gelişmedi (p=0,01). PCR-pozitif hastalarda neonatal mortalite PCR-negatif hastalara kıyasla önemli ölçüde daha yüksekti (p=0,011), PCR-pozitif hastalardan doğan tüm bebekler kaybedildi. Serklaj grubundaki PCR-negatif hastaların %60'ının bebekleri ise sağlıklı olarak taburcu edilmiştir.

Sonuç: Bu çalışmada, mikrobiyom durumu ile acil serklaj prosedürlerinin başarısı arasında olası bir bağlantının varlığı vurgulanmıştır.

Keywords

servikal yetmezlik, acil serklaj, perinatal sonuçlar, polimeraz zincir reaksiyonu, prolabe amniyon membranı

Using 16S rRNA-Specific PCR on Preoperative Amniotic Fluid Samples to Predict Success of Emergency Cerclage Placement

Abstract

Introduction: The success of emergency cerclage in the presence of incompetent cervix and protruding fetal membrane is a matter of debate. Theories suggest that the microbiome may play an important role in influencing the structural integrity of the cervix. Hence, understanding the microbiome status before cerclage operation may have value in predicting the success rate of the procedure. This study aimed to examine the existence of microbial organisms in amniotic fluid through polymerase chain reaction (PCR) detection of 16S rRNA species and assess its correlation with perinatal outcomes in mid-trimester emergency cerclage cases.

Methods: Nineteen patients were scheduled for amniodrainage and emergency cerclage due to cervical insufficiency and they formed the cerclage group. The control group was formed by 56 patients who were seeking consultation for routine control and underwent karyotyping and physical examination at our clinic.

Results: In the cerclage group, PCR results were negative in all control group patients, whereas nine patients tested positive for PCR (p<0.001). Chorioamnionitis was observed in five PCR-positive patients but not in PCR-negative patients (p<0.001), and three newborns had sepsis in PCR-positive patients, while none were observed in PCR-negative patients (p=0.01). Neonatal mortality was significantly higher in PCR-positive patients compared to PCR-negative patients (p=0.011), with all infants born to PCR-positive patients succumbing. Conversely, 60% of the infants of PCR-negative patients in the cerclage group were discharged in good health.

Conclusions: In this study, the presence of a potential link between the microbiome status and the success of emergency cerclage procedures was underlined.

Keywords

cervical insufficiency, emergency cerclage, perinatal outcome, polymerase chain reaction, prolapsed amniotic membranes

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