Elektif ve Acil Serklaj Uygulamalarının Perinatal Sonuçlar Açısından Analizi

Abstract

Amaç: Sevk alan üçüncü basamak merkezimizde yapılan elektif ve acil servikal serklaj sonuçlarını incelemeyi ve etkinliklerini değerlendirmeyi amaçladık Gereçler ve Yöntem: Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde Ocak 2016 ile Ocak 2020 arasında servikal yetmezlik tanısıyla servikal serklaj yapılan toplam 56 hastanın sonuçları retrospektif olarak incelenmiştir. Transvajinal olarak Mc-Donald tipi serklaj uygulanan hastalar çalışmaya dahil edilmiştir. Çoğul gebeliği olan, abdominal serklaj uygulanan ve doğum sonuçlarına ulaşılamayan hastalar çalışma dışı bırakılmıştır. Serklaj yapılma endikasyonuna göre hastalar; elektif serklaj (öykü endikasyonlu) ve acil serklaj (fizik muayene ve ultrasonografi endikasyonlu) olmak üzere iki grupta incelenmiştir. Bulgular: Serklaj işleminin yapıldığı gebelik haftası elektif ve acil grupları için sırasıyla 20.8±0.7 ve 13.9±0.1 hafta olarak saptandı. Elektif serklaj yapılan grupta serklaj işlemi ile doğum arasında geçen süre ile doğumun gerçekleştiği hafta belirgin olarak daha fazlaydı (151.1±6.5 gün / 35.2±0.9 hafta vs 23.7±18.5 gün / 26.6±1.4 hafta ). Bununla ilişkili olarak da doğum ağırlığı elektif serklaj yapılan grupta acil serklaj yapılan gruptan anlamlı olarak daha fazlaydı ( 2913.7±129 gr vs 1611.4±232.2 gr). Yenidoğan yoğun bakım gereksinimi ise elektif serklaj grubunda daha azdı. Doğum şekli ve abortus oranı açısından ise her iki grup arasında istatiksel anlamlı fark yoktu. Sonuç: Ağrısız servikal açıklık ile başvuran ya da ultrasonografide belirgin kısa servikse sahip hastalarda yapılan acil serklaj da elektif serklaj kadar olmamakla birlikte gebelik süresini uzatmada ve kötü perinatal sonuçları azaltmada etkilidir. Elektif serklaja kıyasla acil serklaj etkinliğini belirlemek için acil serklaj uygulanan hastaların daha iyi randomize edildiği daha fazla hasta sayısı ile yapılacak prospektif çalışmalara ihtiyaç vardır.

Keywords

• Servikal serklaj
• servikal yetmezlik
• preterm doğum

Analysis of Elective and Emergency Cerclage Practice in Terms of Perinatal Results

Abstract

Aim: We aimed to examine the elective and emergency cervical cerclage results performed in our referral tertiary care center and evaluate their effectiveness. Materials and Methods: The results of 56 patients who underwent cervical cerclage with the diagnosis of cervical insufficiency in Bursa Yüksek İhtisas Training and Research Hospital between January 2016 and January 2020 were retrospectively analyzed. Patients who underwent Mc-Donald type transvaginal cerclage were included in the study. Patients with multiple pregnancies, abdominal cerclage, and deliver results that could not be reached were excluded from the study. According to the cerclage indication, patients were examined in two groups as elective cerclage (with history indication) and emergency cerclage (with physical examination and ultrasonography indication). Results: The gestational week when cerclage was performed was determined as 20.8 ± 0.7 and 13.9 ± 0.1 weeks for elective and emergency groups, respectively. In the elective cerclage group, the time between cerclage procedure and delivery and the week of delivery was significantly higher (151.1 ± 6.5 days / 35.2 ± 0.9 weeks vs. 23.7 ± 18.5 days / 26.6 ± 1.4 weeks). In relation to this, birth weight was significantly higher in the elective cerclage group than in the emergency cerclage group (2913.7 ± 129 gr vs. 1611.4 ± 232.2 g). Neonatal intensive care requirement was less in the elective cerclage group. There was no statistically significant difference between the two groups in terms of delivery method and abortion rate. Conclusion: Emergency cerclage performed in patients presenting with painless cervical aperture or having a prominent short cervix on ultrasonography effectively prolongs gestational period and reduces poor perinatal outcomes, although not as much as elective cerclage. There is a need for prospective studies to determine the efficacy of emergency cerclage compared to elective cerclage, in which patients with emergency cerclage are better randomized and with a larger number of patients.

Keywords

• Cervical cerclage
• cervical insufficiency
• preterm birth

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