İlk Trimesterde Bradikardik Olan Fetuslar Terme Ulaşıyor Mu?

Year 2022, , 105 - 109, 22.09.2022

Seval Yılmaz Ergani , Yıldız Akdaş Reis , Susam Çelik , Müjde Can İbanoğlu , Okan Aytekin , Metin Altay , Leyla Mollamahmutoğlu , Cantekin İskender

https://doi.org/10.46969/EZH.1155720

Abstract

Amaç: İlk trimesterde bradikardi saptanan fetüslerin kontrol grubu ile kıyaslanarak obstetrik ve perinatal sonuçlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Retrospektif kohort dizayn edilen bu çalışmayla hastanemizde takip ve tedavisi yapılmış ilk trimesterde bradikardi tespit edilen 58 gebe ve 276 normal gebe kontrol grubu olarak alınarak çalışmaya dahil edildi. Her hasta için fetal kalp hızı, yaş, parite, abortus sayısı, gebelik haftası, vücut kitle indeksi (VKİ), yardımcı üreme teknikleri kullanılıp kullanılmadığı, 11-14 hafta arası ölçülen nukal translusensi (NT) değeri, gebeliğin nasıl sonuçlandığı, doğum haftası, doğum şekli, yenidoğan yoğun bakım ünitesinde kaç gün yatış olduğu, fetal cinsiyet not alındı ve bu iki grubun perinatal sonuçları karşılaştırıldı.
Bulgular: Ortalama yaş bradikardik grupta 27.8 ± 6.1 olup, kontrol grubunda 28.2±6.0 idi. İlk trimester NT ortalaması bradikardik grupta 1.56 ± 0.61 olup, kontrol grubunda 1.26 ± 0.34 ölçüldü. Bradikardik grubun NT’si istatistiksel olarak anlamlı düzeyde kontrol grubundan daha fazla idi (p<0.001). Yine haftasına göre NT değerleri kıyaslandığında 95 persantilin üzerinde NT ölçülen hasta sayısı bradikardik grupta %13.8 (n=8) olup, kontrol grubunda %1.8 (n=5) ile istatistiksel olarak anlamlı düzeyde daha yüksek bulunmuştur (p<0.001). Bradikardik grubun %81’i (n=47) 20. haftadan önce intrauterin exitus olmuş, %12.1’i (n=7) abortus ile hastaneye başvurmuş, %6.9’u (n=4) ise canlı doğumla sonuçlanmıştır. Kontrol grubunun %2.4’ü (n=5) 20. haftadan önce intrauterin exitus olmuş, %1.4’ü (n=3) abortus ile hastaneye başvurmuş, %94.7’si (n=197) canlı doğumla sonuçlanmış ve %1.4’ü (n=3) 20. haftadan sonra intrauterin exitus olmuştu.
Sonuç: İlk trimesterde bradikardik olan fetuslarda abortus, intrauterin exitus, yüksek NT değeri gibi kötü gebelik sonuçların normal gebelerden daha yüksek olduğu görülmüştür.

Keywords

Abortus, fetal bradikardi, ilk trimester

Supporting Institution

Yok

Do Fetuses Who Are Bradycardic in The First Trimester Reach Term?

Abstract

Objective: The aim of this study was to evaluate the obstetric and perinatal outcomes of fetuses diagnosed with bradycardia in the first trimester by comparing them with the control group.
Material and Method: In this study, which was designed as a retrospective cohort study, 58 pregnant women who were followed up and treated in our hospital and diagnosed with bradycardia in the first trimester were included as the study group. 276 normal pregnant women were included in the study as a control group. For each patient, fetal heart rate, age, parity, number of abortions, gestational week, body mass index (BMI), whether assisted reproductive techniques were used, NT value measured between 11-14 weeks, type of abortion, week of delivery, type of delivery, neonatal intensive care unit admission, number of hospital days, and fetal sex were noted, and the perinatal outcomes of these two groups were compared.
Results: The mean age was 27.8 ± 6.1 years in the bradycardic group and 28.2 ± 6.0 years in the control group. The mean value of NT in the first trimester was 1.56 ± 0.61 in the bradycardic group and 1.26 ± 0.34 in the control group, and the NT of the bradycardic group was statistically significantly higher than that of the control group (p < 0.001). Also, when comparing NT values by week, the number of patients with NT above the 95th percentile was 13.8% (n=8) in the bradycardic group and was statistically significantly higher than 1.8% (n=5) in the control group (p < 0.001). In the bradycardic group, 81% (n=47) had an intrauterine exitus before 20 weeks, 12.1% (n=7) were hospitalized with an abortion, and 6.9% (n=4) resulted in a live birth. 2.4% (n=5) of the control group had an intrauterine exitus before the 20th week, 1.4% (n=3) were hospitalized with an abortion, 94.7% (n=197) resulted in a live birth, and 1.4% (n=3) had an intrauterine exit after the 20th week.
Conclusion: Worse pregnancy outcomes were found such as abortion, intrauterine exitus, and high NT scores in fetuses who were bradycardic in the first trimester than in normal pregnant women.

Keywords

Abortion, fetal bradycardia, first trimester

References

• Knudsen UB, Hansen V, Juul S, Secher NJ. Prognosis of a new pregnancy following previous spontaneous abortions. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1991;39(1):31-6.
• Mackenzie WE, Holmes DS, Newton JR. Spontaneous abortion rate in ultrasonographically viable pregnancies. Obstetrics and gynecology. 1988;71(1):81-3.
• Doubilet PM, Benson CB. Outcome of first-trimester pregnancies with slow embryonic heart rate at 6–7 weeks gestation and normal heart rate by 8 weeks at US. Radiology. 2005;236(2):643-6.
• Yapar EG, Ekici E, Gökmen O. First trimester fetal heart rate measurements by transvaginal ultrasound combined with pulsed Doppler: an evaluation of 1331 cases. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1995;60(2):133-7.
• Hanprasertpong T, Phupong V. First trimester embryonic/fetal heart rate in normal pregnant women. Archives of Gynecology and Obstetrics. 2006;274(5):257-60.
• Shenker L, Astle C, Reed K, Anderson C. Embryonic heart rates before the seventh week of pregnancy. The Journal of Reproductive Medicine. 1986;31(5):333-5.
• Ersoy E, Ersoy AÖ, Çelik EY, Özler S, Altay M, Gelişen O. Ultrasonografik Belirteçlerin İlk Trimester Gebelik Sonuçlarını Öngörmedeki Rolü. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2015;12(2):75-9.
• Laboda L, Estroff J, Benacerraf B. First trimester bradycardia. A sign of impending fetal loss. Journal of ultrasound in medicine. 1989;8(10):561-3.
• Walker AM, Cannata J, Dowling MH, Ritchie B, Maloney JE. Sympathetic and parasympathetic control of heart rate in unanaesthetized fetal and newborn lambs. Neonatology. 1978;33(3-4):135-43.
• Qasim SM, Sachdev R, Trias A, Senkowski K, Kemmann E. The predictive value of first-trimester embryonic heart rates in infertility patients. Obstetrics & Gynecology. 1997;89(6):934-6.
• Brigham SA, Conlon C, Farquharson RG. A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. Human Reproduction. 1999;14(11):2868-71.
• Chittacharoen A, Herabutya Y. Slow fetal heart rate may predict pregnancy outcome in first-trimester threatened abortion. Fertility and sterility. 2004;82(1):227-9.
• Wilcox AJ, Weinberg CR, O’Connor JF, Baird DD, Schlatterer JP, Canfield RE, et al. Incidence of early loss of pregnancy. New England Journal of Medicine. 1988;319(4):189-94.
• Wong S, Chau K, Ho L. Fetal bradycardia in the first trimester: an unusual presentation of atrial extrasystoles. Prenatal Diagnosis: Published in Affiliation With the International Society for Prenatal Diagnosis. 2002;22(11):976-8.
• Liao A, Snijders R, Geerts L, Spencer K, Nicolaides K. Fetal heart rate in chromosomally abnormal fetuses. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2000;16(7):610-3.
• Sciarrone A, Masturzo B, Botta G, Bastonero S, Campogrande M, Viora E. First-trimester fetal heart block and increased nuchal translucency: an indication for early fetal echocardiography. Prenatal Diagnosis: Published in Affiliation With the International Society for Prenatal Diagnosis. 2005;25(12):1129-32.