Mekonyumlu Gebeliklerde Doğum Eyleminin ve Sonuçlarının Değerlendirilmesi: Prospektif Kohort Çalışması

Year 2022, , 121 - 127, 22.09.2022

Fatma Ozlu Akkuş , Canan Tapkan , Müjde Can İbanoğlu , Nagihan Cengaver , Elif Gül Yapar Eyi

https://doi.org/10.46969/etlikzubeyde.1153588

Abstract

Amaç: Bu çalışmanın amacı, düşük riskli bir gebelikte mekonyum boyalı amniyotik sıvı için risk faktörlerini belirlemek ve mekonyum boyalı amniyotik sıvı (MBAS) varlığındaki doğumlarda doğum komplikasyonlarını ve yenidoğan sonuçlarını değerlendirmektir.
Gereç ve Yöntemler: Bu prospektif çalışma Nisan 2015-Eylül 2015 tarihleri arasında Ankara Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi’nde yapıldı. Çalışmaya 37. gebelik haftasına ulaşmış tekil gebelik ve baş pozisyonu olan 351 kadın dahil edildi. Bilinen kronik sistemik hastalıkları, gebelik komplikasyonları ve geçirilmiş uterin cerrahisi olan kadınlar çalışma dışı bırakıldı. Bu çalışmaya MBAS’lı 151 olgu ve berrak amniyotik sıvısı olan rastgele seçilmiş 200 kontrol olgusu dahil edildi. İki grubu anne yaşı, gravidite, parite, gebelik yaşı, intrapartum maternal ateş, vücut kitle indeksi (VKİ), doğum süresi, kardiyotokografik değerler, doğum şekli, neonatal sonuç ve yenidoğan yoğun bakım ünitesine yatış oranları açısından karşılaştırdık.
Bulgular: Çalışmamızda doğumda mekonyum boyanması olan yenidoğanların %2,6’sında (4/151) mekonyum aspirasyon sendromu (MAS) gelişti. MBAS grubunda gebelik yaşı, intrapartum maternal ateş ve VKİ anlamlı olarak yüksekti (p=0,003). Doğumun aktif fazının süresi (6 cm’den 10 cm’ye servikal dilatasyon) her iki grupta benzerdi ve MBAS grubunda doğumun ikinci fazının süresi daha uzundu (p=0,002). MBAS, kardiyotokografik incelemelerde, doğum komplikasyonlarında ve yenidoğan sonuçlarında artan sayıda anormal sonuçla ilişkili bulundu (p < 0,001).
Sonuç: Mekonyum boyalı amniyotik sıvı ile yapılan doğumlar artmış morbidite ile ilişkilidir; bu nedenle intrapartum muayeneler daha sık ve dikkatli yapılmalı ve olası olumsuz yenidoğan sonuçlarını azaltmak için doğum sırasında çocuk doktorları ile işbirliği içinde önlemler alınmalıdır.

Keywords

Mekonyum boyalı amniyon sıvı, mekonyum aspirasyon sendromu, risk faktörleri, neonatal sonuç

Deliveries with Meconium-Stained Amniotic Fluid and Outcomes: A Prospective Cohort Study

Abstract

Background: The aim of this study was to determine the risk factors for meconium-stained amniotic fluid in a low-risk pregnancy and to evaluate birth complications and neonatal outcomes in deliveries with meconium-stained amniotic fluid (MSAF).
Material and Methods: This prospective study was conducted between April 2015 and September 2015 at Ankara Zekai Tahir Burak Women’s Health Education and Research Hospital. 351 women with singleton pregnancies and cephalic position who had reached 37 weeks of gestation were included in the study. Women with known chronic systemic diseases, pregnancy complications, and previous uterine surgery were excluded. 151 cases with MSAF and 200 randomly selected control cases with clear amniotic fluid were included in this study. We compared the two groups in terms of maternal age, gravidity, parity, gestational age, intrapartum maternal fever, body mass index (BMI), duration of labor, cardiotocographic values (CTG), mode of delivery, neonatal outcomes, and admission to the neonatal intensive care unit.
Results: In our study, meconium aspiration syndrome (MAS) developed in 2.6% (4/151) of neonates with meconium staining at birth. Gestational age, intrapartum maternal fever and BMI were significantly increased in the MSAF group (p=0.003). The duration of the active phase of labor (cervical dilation from 6 cm to 10 cm) was similar in both groups, and the duration of the second phase of labor was longer in the MSAF group (p=0.002). MSAF was associated with an increased number of abnormal results in cardiotocographic examinations, birth complications, and neonatal outcome (p < 0.001).
Conclusion: Deliveries with meconium-stained amniotic fluid are associated with increased morbidity; therefore, intrapartum examinations should be performed more frequently and carefully, and precautions should be taken during labor in collaboration with pediatricians to reduce potential adverse neonatal outcomes.

Keywords

Meconium stained amniotic fluid, meconium aspiration syndrome, risc factors, neonatal outcome

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