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UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ

Year 2017, Volume: 18 Issue: 2, 49 - 54, 17.04.2017
https://doi.org/10.18229/kocatepetip.344600

Abstract

ÖZ

AMAÇ: Uterin arter doppler bulguları ile alfa fetoprotein (AFP) / beta-human koryonik gonadotropin (β-hCG) değerlerinin perinatal sonuçlarla ilişkisini araştırmak.

GEREÇ VE YÖNTEM: Temmuz 2009’dan itibaren gebe polikliniğine başvuran, 18. gebelik haftasına girmemiş ilk elli gebe incelenmeye alındı. Çalışmaya 49 gebe dahil edildi ve prospektif olarak izlendi.
Gebeliğin 16-18. haftaları arasında ölçülen AFP ve β-hCG düzeyleri ile 22-24. gebelik haftaları arasında suprapubik olarak bakılan uterin arter doppler değerleri kaydedildi. Dışlanma kriterleri olarak, gebelikten önce hipertansiyon olması veya önceki gebelikte preeklampsi-eklampsi öyküsü, tekrarlayan gebelik kayıpları, düşük doğum ağırlıklı yenidoğan hikayesi, kalp ya da renal hastalık hikayesi, diabetes mellitus, antikoagulan veya aspirin tedavisi belirlendi. Verilerin karşılaştırılmasında nonparametrik özelliklerinden dolayı ki-kare testi uygulandı.

BULGULAR: Gebelerin yaşları 19 ile 35 yaş arasındaydı. Ortalama gebelik sayısı 2.1; ortalama parite 1.6 olarak saptandı. Uterin arter dopler, uterin arter çentiği ve β-hCG değerleri ile perinatal sonuçlar arasında bir ilişki saptanamadı. AFP değeri yüksek olan hastaların tümünde intrauterin gelişme geriliği tespit edildi. Ayrıca hastaların 4’ünde intrauterin gelişme geriliği, 9’unda erken doğum, 7’sinde gestasyonel diabet, 2’sinde preeklampsi, 2’sinde fetal distress ve 6’sında mekonyum saptandı. İntrauterin gelişme geriliği dışındaki perinatal sonuçlarla bir bağlantı tespit edilemedi.

SONUÇ: Kötü obstetrik sonuçları öngörebilmek adına bir takım testler yapılmaktadır fakat faydaları sınırlıdır. Dolayısıyla daha spesifik serum belirteçlerinin ve ultrasonografik parametrelerin belirlenerek, gebeliğin seyri sırasında ne tür risklerle karşılaşılabileceğinin saptanması, hem koruyucu hekimlik hem de komplikasyonların tedavisi açısından çok faydalı olacaktır.

References

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  • Enders AC, Carter AM. Review: The evolving placenta:different developmental paths to a hemochorial relationship. Placenta 2012; 33: 92-8.
  • Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, VarnerMW et al. The utility of uterine artery Doppler velocimetry in prediction of preeclampsia in a low-risk population. Obstet Gynecol. 2012;120(4):815-22
  • Naicker T, Khedun SM, Moodley J, Pijnenborg R. Quantitativeanalysis of trophoblast invasion in preeclampsia. Acta Obstet Gynecol Scand 2003; 82(8): 722-9.
  • Lyall F, Robson SC, Bulmer JN. Spiral artery remodelingand trophoblast invasion in preeclampsia and fetal growth restriction: relationship to clinical outcome. Hypertension 2013; 62(6): 1046-54.
  • El-Hamedi, Shillito J, Simpson NA, Walker JJ. A prospectiveanalysis of the role of uterine artery Doppler waveform notching in the assessment of at-risk pregnancies. Hypertens Pregnancy 2005; 24(2): 137-45.
  • Morris RK, Cnossen JS, Langejans M, Robson SC, Kleijnen J, Ter Riet G, et al. Serum screening with Down’s syndrome markers to predict pre-eclampsia and small for gestational age: systematic review and meta-analysis. BMC Pregnancy Childbirth 2008; 8: 33-52.
  • Tancrède S, Bujold E, Giguère Y, Renald MH, Girouard J, Forest JC. Mid-trimester maternal serum AFP and hCG as markers of preterm and term adverse pregnancy outcomes. JOGC 2015; 37(2): 111-6.
  • Spaggiari E, Ruas M, Dreux S, Valat AS, Czerkiewicz I, Guimiot F, et al. Management strategy in pregnancies with elevated second-trimester maternal serum alpha-fetoprotein based on a second assay. AJOG 2013; 208(4): 303.e1-7
  • Gagnon A1, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA et al. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can. 2008;30(10):918-49.
  • A. Gagnon, R.D. Wilson, F. Audibert, V.M. Allen, C. Blight, J.A.Brock, et al. Obstetrical complications associated with abnormal maternal serum markers analytes. JOGC 2008; 30(10): 918-49.
  • Roman A, Desai N, Krantz D, Liu HP, Rosner J, Vohra N,Rochelson B. Maternal serum analytes as predictors of IUGR with different degrees of placental vascular dysfunction. Prenat Diagn 2014; 34(7): 692-8.
  • Androutsopoulos G, Gkogkos P, Decavalas G. Mid-trimestermaternal serum HCG and alpha fetal protein levels: clinical significance and prediction of adverse pregnancy outcome. Int J Endocrinol Metab 2013; 11(2): 102-6.
  • Askie LM, Duley L, Henderson-Smart DJ, Stewart LA.Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 2007; 369(9575): 1791-8.
  • Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F,Marcoux S, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: A meta-analysis. Obstet Gynecol 2010; 116(2): 402-14.
  • Bujold E, Morency AM, Roberge S, Lacasse Y, Forest JC,Giguere Y. Acetylsalicylic acid for the prevention of preeclampsia and intra-uterine growth restriction in women with abnormal uterine artery Doppler: a systematic review and meta-analysis. JOGC 2009; 31(9): 818-26.
  • Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L, Torloni MR.Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2014;6:CD001059
  • Fleischer A, Schulman H, Farmakides G, Bracero L, GrunfeldL, Rochelson B, et al. Uterine artery Doppler velocimetry in 100 pregnant women with hypertension. AJOG 1986; 154(4): 806-13.
  • Ay E, Kavak N, Elter K, Gökaslan H, Pekin T: Screening for preeclampsia by using maternal serum inhibin A, βHCG, estriol and AFP levels and uterine artery Doppler in the second trimestr of pregnancy. ANZJOG 2005; 45(4): 283-8.
  • Barkehall-Thomas A, Wilson C, Baker L, ni Bhuinneain M, Wallace EM. Uterine artery Doppler velocimetry for the detection of adverse obstetric outcomes in patients with elevated mid-trimester beta-human chorionic gonadotrophin. Acta Obstet Gynecol Scand 2005; 84(8): 743-7.
  • El-Baradie SM, Mahmoud M, Makhlouf HH. Elevated serum levelsof interleukin-15, interleukin-16, and human chorionic gonadotropin in women with preeclampsia. J Obstet Gynaecol Can. 2009;31(2):142-8.54
Year 2017, Volume: 18 Issue: 2, 49 - 54, 17.04.2017
https://doi.org/10.18229/kocatepetip.344600

Abstract

References

  • KAYNAKLAR
  • Thangaratinam S, Langenveld J, Mol BW, Khan KS. Predictionand primary prevention of pre-eclampsia. Best Pract Res Clin Obstet Gynaecol 2011; 25(4): 419-33.
  • Enders AC, Carter AM. Review: The evolving placenta:different developmental paths to a hemochorial relationship. Placenta 2012; 33: 92-8.
  • Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, VarnerMW et al. The utility of uterine artery Doppler velocimetry in prediction of preeclampsia in a low-risk population. Obstet Gynecol. 2012;120(4):815-22
  • Naicker T, Khedun SM, Moodley J, Pijnenborg R. Quantitativeanalysis of trophoblast invasion in preeclampsia. Acta Obstet Gynecol Scand 2003; 82(8): 722-9.
  • Lyall F, Robson SC, Bulmer JN. Spiral artery remodelingand trophoblast invasion in preeclampsia and fetal growth restriction: relationship to clinical outcome. Hypertension 2013; 62(6): 1046-54.
  • El-Hamedi, Shillito J, Simpson NA, Walker JJ. A prospectiveanalysis of the role of uterine artery Doppler waveform notching in the assessment of at-risk pregnancies. Hypertens Pregnancy 2005; 24(2): 137-45.
  • Morris RK, Cnossen JS, Langejans M, Robson SC, Kleijnen J, Ter Riet G, et al. Serum screening with Down’s syndrome markers to predict pre-eclampsia and small for gestational age: systematic review and meta-analysis. BMC Pregnancy Childbirth 2008; 8: 33-52.
  • Tancrède S, Bujold E, Giguère Y, Renald MH, Girouard J, Forest JC. Mid-trimester maternal serum AFP and hCG as markers of preterm and term adverse pregnancy outcomes. JOGC 2015; 37(2): 111-6.
  • Spaggiari E, Ruas M, Dreux S, Valat AS, Czerkiewicz I, Guimiot F, et al. Management strategy in pregnancies with elevated second-trimester maternal serum alpha-fetoprotein based on a second assay. AJOG 2013; 208(4): 303.e1-7
  • Gagnon A1, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA et al. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can. 2008;30(10):918-49.
  • A. Gagnon, R.D. Wilson, F. Audibert, V.M. Allen, C. Blight, J.A.Brock, et al. Obstetrical complications associated with abnormal maternal serum markers analytes. JOGC 2008; 30(10): 918-49.
  • Roman A, Desai N, Krantz D, Liu HP, Rosner J, Vohra N,Rochelson B. Maternal serum analytes as predictors of IUGR with different degrees of placental vascular dysfunction. Prenat Diagn 2014; 34(7): 692-8.
  • Androutsopoulos G, Gkogkos P, Decavalas G. Mid-trimestermaternal serum HCG and alpha fetal protein levels: clinical significance and prediction of adverse pregnancy outcome. Int J Endocrinol Metab 2013; 11(2): 102-6.
  • Askie LM, Duley L, Henderson-Smart DJ, Stewart LA.Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 2007; 369(9575): 1791-8.
  • Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F,Marcoux S, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: A meta-analysis. Obstet Gynecol 2010; 116(2): 402-14.
  • Bujold E, Morency AM, Roberge S, Lacasse Y, Forest JC,Giguere Y. Acetylsalicylic acid for the prevention of preeclampsia and intra-uterine growth restriction in women with abnormal uterine artery Doppler: a systematic review and meta-analysis. JOGC 2009; 31(9): 818-26.
  • Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L, Torloni MR.Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2014;6:CD001059
  • Fleischer A, Schulman H, Farmakides G, Bracero L, GrunfeldL, Rochelson B, et al. Uterine artery Doppler velocimetry in 100 pregnant women with hypertension. AJOG 1986; 154(4): 806-13.
  • Ay E, Kavak N, Elter K, Gökaslan H, Pekin T: Screening for preeclampsia by using maternal serum inhibin A, βHCG, estriol and AFP levels and uterine artery Doppler in the second trimestr of pregnancy. ANZJOG 2005; 45(4): 283-8.
  • Barkehall-Thomas A, Wilson C, Baker L, ni Bhuinneain M, Wallace EM. Uterine artery Doppler velocimetry for the detection of adverse obstetric outcomes in patients with elevated mid-trimester beta-human chorionic gonadotrophin. Acta Obstet Gynecol Scand 2005; 84(8): 743-7.
  • El-Baradie SM, Mahmoud M, Makhlouf HH. Elevated serum levelsof interleukin-15, interleukin-16, and human chorionic gonadotropin in women with preeclampsia. J Obstet Gynaecol Can. 2009;31(2):142-8.54
There are 22 citations in total.

Details

Subjects Health Care Administration
Journal Section Articles
Authors

Mehmet Sipahi

Vehbi Yavuz Tokgöz

Soner Recai Öner This is me

Mehmet Kulhan

Gözde Kulhan This is me

Mehmet Özeren

Publication Date April 17, 2017
Acceptance Date May 30, 2016
Published in Issue Year 2017 Volume: 18 Issue: 2

Cite

APA Sipahi, M., Tokgöz, V. Y., Öner, S. R., Kulhan, M., et al. (2017). UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ. Kocatepe Tıp Dergisi, 18(2), 49-54. https://doi.org/10.18229/kocatepetip.344600
AMA Sipahi M, Tokgöz VY, Öner SR, Kulhan M, Kulhan G, Özeren M. UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ. KTD. April 2017;18(2):49-54. doi:10.18229/kocatepetip.344600
Chicago Sipahi, Mehmet, Vehbi Yavuz Tokgöz, Soner Recai Öner, Mehmet Kulhan, Gözde Kulhan, and Mehmet Özeren. “UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ”. Kocatepe Tıp Dergisi 18, no. 2 (April 2017): 49-54. https://doi.org/10.18229/kocatepetip.344600.
EndNote Sipahi M, Tokgöz VY, Öner SR, Kulhan M, Kulhan G, Özeren M (April 1, 2017) UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ. Kocatepe Tıp Dergisi 18 2 49–54.
IEEE M. Sipahi, V. Y. Tokgöz, S. R. Öner, M. Kulhan, G. Kulhan, and M. Özeren, “UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ”, KTD, vol. 18, no. 2, pp. 49–54, 2017, doi: 10.18229/kocatepetip.344600.
ISNAD Sipahi, Mehmet et al. “UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ”. Kocatepe Tıp Dergisi 18/2 (April 2017), 49-54. https://doi.org/10.18229/kocatepetip.344600.
JAMA Sipahi M, Tokgöz VY, Öner SR, Kulhan M, Kulhan G, Özeren M. UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ. KTD. 2017;18:49–54.
MLA Sipahi, Mehmet et al. “UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ”. Kocatepe Tıp Dergisi, vol. 18, no. 2, 2017, pp. 49-54, doi:10.18229/kocatepetip.344600.
Vancouver Sipahi M, Tokgöz VY, Öner SR, Kulhan M, Kulhan G, Özeren M. UTERİN ARTER DOPPLER, AFP VE Β-HCG’NİN PERİNATAL SONUÇLAR AÇISINDAN DEĞERLENDİRİLMESİ. KTD. 2017;18(2):49-54.

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