Üçüncü basamak bir hastanede servikal serklaj operasyonlarının prognozu

Yıl 2024, Cilt: 17 Sayı: 1, 139 - 149, 30.04.2024

Şevki Göksun Gökulu , Cüneyt Eftal Taner

Öz

Amaç: Bu çalışmada amacımız hastanemizde preterm doğumu önlemek için yapılan servikal serklaj tedavisinin etkinliğini ve sonuçlarını değerlendirmektir. Yöntem: İzmir Ege Doğumevi ve Kadın Hastalıkları Eğitim ve Araştırma Hastanesi’nde Nisan 2005 -Ağustos 2008 tarihleri arasında servikal serklaj yapılmış 51 gebeyi içeren retrospektif bir çalışmadır. Hastaların yaş, meslek, eğitim, ekonomik durum, sigara ve alkol kullanımı gibi demografik özellikleri kaydedildi. Gebelik ve doğum sayısı, düşük sayısı, tekrarlayan erken doğum sayısı, 2. trimestir düşük sayısı, gebelikte düşük tehdidi öyküleri de incelendi. Çalışmaya alınan 51 gebenin hepsine Mcdonald tarzı serklaj operasyonu yapılmıştır. Gebeler çalışmada 37 hafta altı ve üstü doğum yapmalarına göre iki gruba ayrıldı. Servikal uzunluk, serklaj haftası, doğum şekli ve serklaj endikasyonlar gruplar arasında karşılaştırıldı. Bulgular: Çalışmamıza alınan 51 gebeden 3 tanesi ikiz gebelik, 1 tanesi üçüz gebelik ve 47 tanesi tekil gebelikti. Tüm olguların yaş ortalaması 28.63±5.64 idi. 2. trimestir düşük sayısı preterm grupta term gruba göre daha yüksek düzeyde saptandı. Preterm grupta gebelikte düşük tehdidi olan olgular %52.2 term grupta ise %35.7 oranında olup istatistiksel olarak anlamlı bulundu. Preterm gruptaki olguların serklaj haftası ortalama 18.52, term gruptaki olguların ise 15.32 olup iki grup arasındaki fark istatistiksel olarak anlamlı bulundu. Preterm olguların doğum haftası ortalama 28.43, term olguların ise 38.21 idi (p<0.05). Sonuç: Servikal ultrasonografik ölçümlere dayalı kısa serviks ve hunileşme nedeni ile yapılan serklajlarda ise miad gebelik dönemi ulaşmada daha etkindir.

Anahtar Kelimeler

preterm doğum, servikal serklaj, servikal yetmezlik

Prognosis of cervical cerclage operations at a tertiary hospital

Öz

Aim: This study aimed to evaluate the efficacy and outcomes of cervical cerclage treatment to prevent preterm labor in our hospital. Method: This retrospective study included 51 pregnant women who underwent cervical cerclage between April 2005 and August 2008 in Izmir Ege Obstetrics and Gynecology Training and Research Hospital. Demographic characteristics such as age, occupation, education, economic status, smoking, and alcohol use were recorded. The number of pregnancies and deliveries, number of miscarriages, number of recurrent preterm deliveries, number of second-trimester miscarriages, and history of threatened miscarriage during pregnancy were also analyzed. All 51 pregnant women included in the study underwent a McDonald-style cerclage operation. The pregnant women were divided into two groups according to delivery below and above 37 weeks of gestation. Cervical length, cerclage week, mode of delivery, and indications for cerclage were compared between the groups. Results: Of the 51 pregnant women in our study, 3 were twin pregnancies, 1 were triplet pregnancies, and 47 were singleton pregnancies. The mean age of all cases was 28.63±5.64 years. The number of second-trimester abortions was higher in the preterm group compared to the term group. The rate of cases with threatened miscarriage was 52.2% in the preterm group and 35.7% in the term group, which was statistically significant. The mean cerclage week was 18.52 in the preterm group and 15.32 in the term group, and the difference between the two groups was statistically significant. The mean gestational age at delivery was 28.43 weeks in the preterm group and 38.21 weeks in the term group (p<0.05). Conclusion: Cerclage performed due to short cervix and funneling based on cervical ultrasonographic measurements is more effective in reaching the term pregnancy.

Anahtar Kelimeler

Preterm birth, cervical cerclage, cervical insufficiency

Kaynakça

• Williams M, Iams JD. Cervical length measurement and cervical cerclage to prevent preterm birth. Clin Obstet Gynecol. 2004;47(4):775–83.
• Hollier LM. Preventing preterm birth: what works, what doesn’t. Obstet Gynecol Surv. 2005;60(2):124–31.
• Guyer B, Hoyert DL, Martin JA, Ventura SJ, MacDorman MF, Strobino DM. Annual summary of vital statistics—1998. Pediatrics. 1999;104(6):1229–46.
• Meis PJ, Goldenberg RL, Mercer BM, Iams JD, Moawad AH, Miodovnik M, et al. The preterm prediction study: risk factors for indicated preterm births. Am J Obstet Gynecol. 1998;178(3):562–7.
• Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstetrics & Gynecology. 2004;104(4):727–33.
• Newman RB, Goldenberg RL, Moawad AH, Iams JD, Meis PJ, Das A, et al. Occupational fatigue and preterm premature rupture of membranes. Am J Obstet Gynecol. 2001;184(3):438–46.
• Luo ZC, Wilkins R, Kramer MS. Effect of neighbourhood income and maternal education on birth outcomes: a population-based study. Cmaj. 2006;174(10):1415–20.
• Thompson JMD, Irgens LM, Rasmussen S, Daltveit AK. Secular trends in socio‐economic status and the implications for preterm birth. Paediatr Perinat Epidemiol. 2006;20(3):182–7.
• Tong VT, England LJ, Rockhill KM, D’Angelo D V. Risks of preterm delivery and small for gestational age infants: effects of nondaily and low‐intensity daily smoking during pregnancy. Paediatr Perinat Epidemiol. 2017;31(2):144–8.
• Findley J, Seybold DJ, Broce M, Yadav D, Calhoun BC. Transvaginal cervical length and tobacco use in Appalachian women: association with increased risk for spontaneous preterm birth. W V Med J. 2015;111(3):22.
• Lundsberg LS, Bracken MB, Saftlas AF. Low-to-moderate gestational alcohol use and intrauterine growth retardation, low birthweight, and preterm delivery. Ann Epidemiol. 1997;7(7):498–508.
• Hussein KL, Mogren I, Lindmark G, Massawe S, Nystrom L. The risks for pre-term delivery and low birth weight are independently increased by the severity of maternal anaemia. South African Medical Journal. 2009;99(2):98–102.
• Simcox R, Shennan A. Cervical cerclage: a review. International Journal of Surgery. 2007;5(3):205–9.
• Johns J, Jauniaux E. Threatened miscarriage as a predictor of obstetric outcome. Obstetrics & Gynecology. 2006;107(4):845–50.
• Mercer BM, Goldenberg RL, Moawad AH, Meis PJ, Iams JD, Das AF, et al. The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. Am J Obstet Gynecol. 1999;181(5):1216–21.
• Ananth C V, Peltier MR, Getahun D, Kirby RS, Vintzileos AM. Primiparity: an ‘intermediate’risk group for spontaneous and medically indicated preterm birth. The Journal of Maternal-Fetal & Neonatal Medicine. 2007;20(8):605–11.
• Ventolini G, Genrich TJ, Roth J, Neiger R. Pregnancy outcome after placement of ‘rescue’Shirodkar cerclage. Journal of Perinatology. 2009;29(4):276–9.
• Daskalakis G, Papantoniou N, Mesogitis S, Antsaklis A. Management of cervical insufficiency and bulging fetal membranes. Obstetrics & Gynecology. 2006;107(2 Part 1):221–6.
• Zhu LQ, Chen H, Chen LB, Liu YL, Tan JP, Wang YH, et al. Effects of emergency cervical cerclage on pregnancy outcome: a retrospective study of 158 cases. Med Sci Monit. 2015;21:1395.
• Odibo AO, Berghella V, To MS, Rust OA, Althuisius SM, Nicolaides KH. Shirodkar versus McDonald cerclage for the prevention of preterm birth in women with short cervical length. Am J Perinatol. 2006;55–60.
• MacDorman MF, Declercq E, Menacker F, Malloy MH. Neonatal mortality for primary cesarean and vaginal births to low‐risk women: application of an “intention‐to‐treat” model. Birth. 2008;35(1):3–8.
• Wang S, Feng L. A single‐center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency. International Journal of Gynecology & Obstetrics. 2017;139(1):9–13.
• Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstetrics & Gynecology. 2005;106(1):181–9.
• Eskandar M, Shafiq H, Almushait MA, Sobande A, Bahar AM. Cervical cerclage for prevention of preterm birth in women with twin pregnancy. International Journal of Gynecology & Obstetrics. 2007;99(2):110–2.