Fetal anomalilere bağlı fetosid olgularında tanı, işlem zamanlaması ve perinatal sonuçların değerlendirilmesi

Year 2025, Volume: 8 Issue: 6, 1049 - 1054, 25.10.2025

Ebu Bekir Sıddık Yılmaz , Erkan Sağlam

Abstract

Amaç:
Bu çalışmanın amacı, tıbbi nedenlerle selektif fetosid uygulanan gebeliklerde fetal anomali etiyolojilerini ve perinatal sonuçları değerlendirmektir.

Yöntemler:
Bu retrospektif gözlemsel çalışmaya, Ocak 2020 ile Ocak 2025 tarihleri arasında Bursa Şehir Hastanesi Perinatoloji Birimi’nde fetosid uygulanan 76 gebelik dahil edilmiştir. Maternal demografik özellikler, fetal anomali türleri ve doğum sonuçları sistematik olarak analiz edilmiştir. Dikoryonik ikiz gebeliklerde fetosid sonrası hayatta kalan ikiz fetüse ait perinatal veriler ayrıca değerlendirilmiştir. Fetosid işlemleri, çoğunlukla 21. gebelik haftasından sonra, deneyimli perinatologlar tarafından ultrason rehberliğinde intrauterin intrakardiyak potasyum klorür (KCl) enjeksiyonu ile fetal asistoli sağlanarak gerçekleştirilmiştir.

Bulgular:
Fetosid için en yaygın endikasyon santral sinir sistemi anomalileri (%39.5) olup, bunu kromozomal anomaliler (%19.7) ve kardiyovasküler anomaliler (%17.1) izlemiştir. En sık rastlanan tanılar arasında anensefali, spina bifida, trizomi 21 ve hipoplastik sol kalp sendromu yer almaktadır.
Dikoryonik ikiz gebeliklerde, sağ kalan fetüsün ortalama doğum haftası 32.8, ortalama doğum ağırlığı ise 2266 gram olarak bulunmuştur. Bu olguların %71.4’ünde 1. dakika Apgar skoru ≥7, %78.6’sında ise 5. dakika Apgar skoru ≥8 olarak saptanmıştır. Yenidoğan yoğun bakım ünitesi (YYBÜ) yatış oranı %9.2’dir.

Sonuç:
Selektif fetosid uygulamalarında en sık görülen endikasyon santral sinir sistemi anomalileridir; bunu kromozomal ve kardiyovasküler anomaliler takip etmektedir. Uygun zamanlama ve hasta seçimi ile uygulandığında, dikoryonik ikiz gebeliklerde selektif fetosid işlemi, sağ kalan fetüs açısından güvenli ve etkili bir yaklaşım gibi görünmektedir. Bu çalışma, Türkiye'den elde edilen değerli verileri sunmakta ve gelecekte yapılacak çok merkezli prospektif araştırmalar için temel oluşturmaktadır.

Keywords

Fetosid , Fetal anomali , Gebelik sonlandırma , Dikoryonik ikiz gebelik , Perinatal sonuçlar

Evaluation of diagnosis, timing of procedure, and perinatal outcomes in fetocide cases due to fetal anomalies

Abstract

Aims: To evaluate the etiologies of fetal anomalies and the perinatal outcomes of pregnancies undergoing medically indicated selective fetocide.
Methods: This retrospective observational study analyzed 76 pregnancies that underwent fetocide at the Perinatology Unit of Bursa City Hospital between January 2020 and January 2025. Maternal demographics, types of fetal anomalies, and delivery outcomes were systematically reviewed. In dichorionic twin pregnancies, perinatal outcomes of the surviving co-twin were assessed separately. Fetocide was predominantly performed after 21 weeks of gestation by experienced perinatologists under ultrasound guidance, using intracardiac potassium chloride (KCl) injection to induce fetal asystole.
Results: Central nervous system anomalies were the most common indication for fetocide (39.5%), followed by chromosomal anomalies (19.7%) and cardiovascular anomalies (17.1%). The most frequent diagnoses included anencephaly, spina bifida, trisomy 21, and hypoplastic left heart syndrome. In dichorionic twin pregnancies, the mean gestational age at delivery of the surviving fetus was 32.8 weeks, with a mean birth weight of 2266 g. Among these, 71.4% had a 1-minute Apgar score ≥7 and 78.6% had a 5-minute Apgar score ≥8. The neonatal intensive care unit (NICU) admission rate was 9.2%.
Conclusion: Central nervous system anomalies were the most common indication for selective fetocide, followed by chromosomal and cardiovascular anomalies. When performed with appropriate timing and patient selection, selective fetocide in dichorionic twin pregnancies it may be a safe and effective approach for the surviving fetus. This study provides valuable data from Turkiye and serves as a foundation for future multicenter prospective research.

Keywords

Fetocide , selective termination , KCl injection , twin pregnancy outcomes , fetal anomal

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