INTRAUTERİN GELİŞME KISITLILIĞI OLAN HASTALARDA SEREBROPLASENTAL ORANIN FETAL İYİLİK HALİNİN BELİRLENMESİNDEKİ ETKİSİNİN GÖSTERİLMESİNE DAİR RETROSPEKTİF ÇALIŞMA

Year 2023, , 1625 - 1632, 30.03.2023

Hatice Laçin Tuğan , Selçuk Özden , Koray Gök

https://doi.org/10.38136/jgon.1065316

Abstract

ÖZET
Amaç: Fetal büyüme kısıtlılığından etkilenen gebeliklerin perinatal sonuçlarını serebroplasental oran kullanarak araştırmak ve öngörmeye çalışmak.
Gereç ve Yöntemler: Doğum öncesi kliniğine başvuran 100 yüksek riskli gebe üzerinde retrospektif bir çalışma yapıldı. 66 hamile kadına ıntra uterin gelişme kısıtlılığı teşhisi kondu. Ve 34 hamile kadına küçük sağlıklı bebek teşhisi kondu. Tüm hastaların temel demografik, geçmiş obstetrik ve tıbbi öyküleri kaydedildi. İntra uterin gelişme kısıtlılığı; sonografik ölçüme dayalı olarak gebelik yaşı için 10 persentilin altındaki tahmini fetal ağırlığı olan gebelere konuldu. 'Küçük sağlıklı bebek' teşhisi ; fetal ağırlığın veya fetal karın çevresi ölçümünün 10. persantilin altında olduğu ancak doppler parametreleri normal olan fetüslere konuldu. Ve bu fetüslerde beklenen büyüme potansiyeline ulaşmasını engelleyen patolojik faktörler yoktu. Gebelikleri değerlendirmek için orta serebral arter ve umbilikal arterlerin doppler ultrasonografisi kullanıldı. Serebroplasental doppler oranının 1'in altında olması anormal kabul edildi. Yenidoğan için olumsuz perinatal sonuçlar tüm hastalar için kaydedildi. Sonuç: 100 gebe serebroplasental orana göre iki gruba ayrıldı. Grup A’ nın serebroplasental oranı 1 den büyüktü (n=87). Grup B’ nin serebroplasental oranı 1 den küçüktü (n=13). Grup B'de perinatal morbidite istatistiksel olarak anlamlı derecede arttı. Anormal serebroplasental orana sahip fetüsler, daha kötü fetal prognoz ile güçlü bir şekilde korele idi. Respiratuar distres sendromu (p = 0.043; p <0.05), yenidoğanın düşük apgar skoru (p = 0.015; p <0.05), mekonyum aspirasyon oranları (p = 0.015; p <0.05) ve yenidoğanlarda hiperbilirubinemi görülme insidansı (p = 0.015) ; p<0.05) Grup B'li yenidoğanlarda anlamlı olarak daha yüksekti (p: 0.022). Yenidoğan yoğun bakım ihtiyacı, prematürite ve perinatal mortalite oranları serebroplasental oran düzeyine göre istatistiksel olarak anlamlı farklılık göstermedi (p> 0.05).

Keywords

İntrauterin gelişme kısıtlılığı, umbilikal arter, orta serebral arter, doppler ultrason, serebroplasental oran, İntrauterin gelişme kısıtlılığı, umbilikal arter, orta serebral arter, doppler ultrason, serebroplasental oran

RETROSPECTIVE STUDY FOR PREDICTING PERINATAL OUTCOME USING CEREBROPLACENTAL RATIO IN FETAL GROWTH RESTRICTED PREGNANCY

Abstract

ABSTRACT
Objective: To investigate and predict perinatal outcomes of pregnancies affected with fetal growth restriction by cerebroplacental ratio.
Material and Methods: A retrospective study was conducted based on 100 high-risk pregnant who referred to the antenatal clinic. 66 pregnant women were diagnosed with ıntrauterine growth restriction. And 34 pregnant women were diagnosed with small for gestational age. Baseline demographic, past obstetric and medical histories were recorded for all patients. Intrauterine growth retardation was defined as an estimated weight below the 10th percentile for gestational age based on sonographic measurement.‘ small for gestational age’ diagnosis shows that fetal weight or fetal abdomainal circunference measurement is below 10th percentile; but it was diagnosed in fetuses with normal doppler parameters and no pathological factors were preventing the fetus from reaching its expected growth potential. Doppler ultrasound of middle cerebral arteries and umbilical arteries were used to assess pregnancies. Cerebroplacental rate (CPR); It is calculated by dividing MCA percentile index to UA percentile index. The cerebroplacental doppler ratio less than 1 was accepted abnormal. Adverse perinatal outcomes for newborns were documented for all cases. Results: 100 pregnant women were classified into two groups according to cerebroplacental ratio. Cerebroplacental ratio ratio of Group A is greater than 1 (n=87). And cerebroplacental ratio ratio of Group B is less than 1 (n=13). Perinatal morbidity statistically significantly increased in Group B. The fetuses with abnormal cerebroplacental ratıo were strongly correlated with worse fetal prognosis. Respiratory distress syndrome rates (p = 0.043; p <0.05), low apgar score of newborn (p = 0.015; p <0.05), meconium aspiration rates (p = 0.015; p <0.05) and incidence of hyperbilirubinemia in newborns (p = 0.015; p <0.05) were significantly higher in the newborns with Group B (p: 0.022). Need for neonatal intensive care, prematurity and perinatal mortality rates did not show a statistically significant difference according to the cerebroplacental ratıo level (p> 0.05).

Keywords

IUGR (Intrauterine growth retardation), umbilical artery, middle cerebral artery, doppler ultrasonography, cerebroplacental ratio, IUGR (Intrauterine growth retardation), umbilical artery, middle cerebral artery, doppler ultrasonography, cerebroplacental ratio

References

• REFERENCES 1) Badawi N, Kurinczuk JJ, Keogh JM, et al.Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998;317:1549-53.
• 2) Unterscheider J, Daly S, Geary MP, Kennelly MM, McAuliffe FM, O’Donoghue K, Hunter A, Morrison JJ, Burke G, Dicker P, Tully EC, Malone FD. Optimizing the definition of intrauterine growth restriction – results of the multicenter prospective PORTO Study. Am J Obstet Gynecol. 2013; 208: 290.e1–6
• 3) Baschat AA ve Galan HI (2017) Intrauterine Growth Restriction. In, Gabbe SG (eds), Obstetrics: Normal and Problem Pregnancies, Seventh Edition. Philadelphia, PA : Elsevier, Chapter 33, pp 737-769.
• 4) Berkley E, Chauhan SP, Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. Society for Maternal-Fetal Medicine Publications Committee, Am J Obstet Gynecol 2012; 206:300
• 5) Gabbe SG, Freeman RD, Goebelsmann U. Obstetrics Normal and Problem Pregnancies. Seventh Edition. Philadelphia, PA : Elsevier, Chapter 33, pp 723
• 6) Hadlock FP, Harrist RB, Sharman RS, DeterRL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements–a prospective study. Am J Obstet Gynecol 1985; 151:333-7.
• 7) Scherjon SA, Smolders-DeHaas H, Kok JH, Zondervan HA: The "brain-sparing" effect: Antenatal cerebral Doppler findings in relation to neurologic outcome in very preterm infants. Am J Obstet Gynecol 1993, 169:169-175.
• 8) Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 1992;79:416-20.
• 9) Acharya G, Wilsgaard T, Bernsten GKR, et al.: References ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol 192:937,2005
• 10) Unterscheider J, Daly S, Geary MP ve ark (2013) Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. Am J Obstet Gynecol, 208:290.e1-6.
• 11) Figueras F, Savchev S, Triunfo S, Crovetto F, Gratacos E. An integrated model with classification criteria to predict small-forgestational- age fetuses at risk of adverse perinatal outcome. Ultrasound Obstet Gynecol2015;45:279-85.
• 12) Khalil AA, Morales-Rosello J, Morlando M, et al. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission? Am J Obstet Gynecol 2015;213:54.e1-10.
• 13) Vollgraff Heidweiller-Schreurs CA, de Boer MA, Heymans MW, Schoonmade LJ, Bossuyt PMM, Mol BWJ, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcomes: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018
• 14) Vollgraff Heidweiller-Schreurs, a IR van Osch, a MW Heymans,b W Ganzevoort,c LJ Schoonmade,d CJ Bax,c BWJ Mol,e CJM de Groot, a PMM Bossuyt,f MA de BoerCerebroplacental ratio in predicting adverse perinatal outcome: a meta-analysis of individual participant data BJOG 2020
• 15) Daphne Moreta, Samuel V, Guy D Eslick, Ronald Benzie. Re-evaluating the role of cerebroplacental ratio in predicting adverse perinatal outcome. European Journal of Obstetrics & Gynecology and Reproductive Biology(22 June 2019 )
• 16) A. Cıobanu1, A.Wrıght2, A. Syngelakı1, D.Wrıght2, R. Akolekar 3 and K.H.Nıcolaıdes 's Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio
• 17) A. Cıobanu1, A.Wrıght2, A. Syngelakı1, D.Wrıght2, R. Akolekar 3 and K.H.Nıcolaıdes 's Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio