Abruptio placentae; risk factors, our follow-up-treatment protocols and relevants results

Year 2009, Volume: 40 Issue: 4, 159 - 166, 01.05.2009

İsa Çetin Mehmet Küçükbaş Vedat Dayıcıoğlu Doğan Vatansever

Abstract

Objective: Within the scope of the majority of the final studies,it is put forth that abruptio plaçentae,preeclampsia and IUGR are varied forms of placental dysfunction.In this study,our objective was to analyze abruptio placentae risk factors, which have a significant role in maternal and fetal mortality- morbidity; to conduct a research on the relevant relation between IUGR and to revise the results of follow-up-treatment protocol, we implemented at Zeynep Kamil Gynecological and Infantile Diseases Training and Research Hospital Department of Obstetrics and Gynecology. Material and methods: This case-control study was conducted prospectively in labour room and caesarean services of the Obstetrics department of Training and Research Hospital Department of Obstetrics and Gynecology on the dates of June 2008 and August2009. Within the scope of the study,112 working groups (abruptio placentae) case 111 control group case take place. Findings: At the current pregnancy,rate of visibility of preeclampsia are statistically significant (p0,05).ODDs rate was determined as 3,101 (95% CI: 0,79-12,3). Rate of visibility ofhypothyroidis is not statistically significant between these groups (p>0,05). ODDs rate was determined as 4,037 (95 % CI: 0,44- 36,70). Result: In our study,we reached the result that preeclampsia increased the risk of abruptio placentae four time;whereas IUGR three times.Furthermore we determined that hypothyroidis increased rate of visibility of abruptio placentae 4,03 7 times. We determined that ourfollow-up-treatment protocolimplemented at our hospital,was in paralel with the majority of current compiled articles related to the issue.

Keywords

Abruptio Placentae, Pre-Eclampsia, Clinical Protocols, Fetal Growth Retardation, Hypothyroidism

Plasenta dekolmanı; risk faktörleri, takip-tedavi protokollerimiz ve sonuçları

Abstract

Amaç: Son çalışmalardan, birçoğunda abruptio plasenta, preeklampsi ve IUGR'nın; plasental disfonksiyonun değişik görünümleri olduğu iddia edilmektedir. lBu çalışmada maternal morbidite- mortalite ve fetal mortalite - morbiditede önemli rol oynayan abruptio plasenta risk faktörlerini analiz etmek; preeklampsi,IUGR ile olan ilişkisini araştırmak ve Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi Kadın Hastalıkları kliniğinde uyguladığımız takip-tedavi protokolümüzün sonuçlarını gözden geçirmeyi amaçladık. Materyal ve metod: Bu vaka-kontrol çalışması, Haziran 2008 ile Ağustos 2009 yılları arasında Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi Kadın Doğum bölümünde doğumhane ve sezaryen servislerinde prospektif olarak yürütülmüştür. Çalışmadav 112 çalışma grubu (plasenta dekolmanı) olgusu ve 111 kontrol grubu olgusu vardır. Bulgular: Şimdiki gebelikte preeklampsi görülme oranları, gruplara göre istatistiksel olarak anlamlı farklılık göstermektedir (p0,05). ODDS oranı 3,101 (%95 CI: 0,79-12,3) olarak saptanmıştır. Grupların hipotiroidi görülme oranları arasında istatistiksel olarak anlamlı farklılık görülmemektedir (p>0,05). ODDS oranı 4,037 (%95 CI: 0,44-36,70) olarak saptadık. Sonuç: Çalışmamızda dekolman riskini, preeklampsinin dört kat ve IUGR'nın üç kat artırdığı sonucuna ulaştık. Ayrıca plasenta dekolmanı görülme riskini hipotiroidinin 4,037 kat artırdığını tespit ettik.Hastanemizde uygulanan takip-tedavi protokolümüzün konuya ilişkin güncel derleme makalelerin çoğunluğu ile paralelik gösterdiğini belirledik.

Keywords

Plasenta ayrılması, Preeklampsi, Klinik protokoller, Fetal gelişim geriliği, Hipotiroidi

References

• 1. Brodsky D,Christou H. Current concept in Intrauterine Growth Restriction.J Intensive care Med 2004,19;307-319
• 2. Hall DR.Abruptio Placentae and Dissminated Intravascular Coagulopathy.Semin Perinatol 2009;33:189-195
• 3. Oyelese Y ve Ananth CV .Placental Abruption. Obstet Gynecol 2006,108:1005-16 4. Matsuda Y,Maeda T,Kouna S. Comparison of neonatal outcome including cerebral palsy between abruptio placenta and placenta previa.Eur J Obstet Gynecol Reprod Biol 2003,106:125-129
• 5. Feinberg RF,Kliman HJ,Cocwood LH. Is oncofetal fibronectin a trophoblast glue for human implatation.Am J Pathol 199,138:537-542
• 6. Faber JJ,Barbara A. Convention for reporting amniotic pressure.Eur J Obstet Gynecol Reprod Biol 1992,47:181
• 7. Madazlı R.Plasenta. 2008.s.325-326,Nobel Tıp Kitapevleri,Istanbul 8. Kramer MS, Usher RH,Pollack R,BodyM, Usher S. Etiologic determinante of abruptio placentae. Obstetrics and Gynecology 1997,89:221- 6 9. Harrington K,Cooper D,Lees C,Hecher K, Campbell S (1996) Doppler ultrasound of the uterine arteries. Ultrasound Obstet Gynecol, 7:182- 8 10. Madazlı R.Plasenta. 2008.S.323-324,Nobel Tip Kitapevleri,İstanbul 11. Dunlop AL,Jack BW,Bottalico JN,Lu MC,et al. The clinical content of preconception care:women with chronic medical conditions.Am J Obstet Gynecol Supplement to december 2008,pp:310- 323
• 12. Cunningham FG, Gant NF,Leveno KJ, Gilstrap LJ,Hauth JC, Wenstrom KD. Williams Doğum Bilgisi,Nobel Tıp Kitapevleri,2005,s.831
• 13. Mar bury MC,Linn S,et al.The association of alcohol consumption with outcome of pregnancy. Am J Puplic Health 1983;73:1165-1168
• 14. Bartholomew RA.Haemorrhages of late pregnancy. With emphasis on placental circulation and the mechanism ofbleeding.Postgraduate Med 1961;30:397-406 15. Sanchez SE,Pacora PN,Farfan JH,Fernandez A,Qiu C,Ananth CV, Williams MA.Risk factors of abruptio placentae amongperuvian women.Am J Obstet Gynecol.2006;194:225-30 16. Nowak R . New push to reduce maternal mortality in poor countries. Science 1995,269: 780- 2
• 17. Kominsky LM, Ananth CV, Prasad Vet al. The influence of maternal cigarette smoking on placental pathology in pregnan cies complicated by abruption Am J obstet gynecol 2007, 197-275el - 275e5
• 18. Mehendale R,Hibbard J,Fazleabas A,Leach R.Placental angiogenesis markers sFlt-1 and PIGF-.response to cigarette smoke. Am J Obstet Gynecol 2007;197:363.el-363.e2
• 19. Peltier MR, Ananth CV, ist he association of maternal smoking and pregnancy induced hypertension dependent on fetal growth? Am J obstet Gynecol 2007, 196: 532.el-532e6
• 20. Ananth CV, Berkowitz GS, SavitzDA, Capinski RH: Placental Abruption and addverse perinatal outcomes. JAMA 1996: 282: 1646
• 21. Karegard M, gennser G. incidence and recurrence rate of abruptio placenta in Sweden . obstet Gynecol 1986: 67: 523-8 22. Sibai BM.İmitator of severe preeclampsi. Semin Perinatol. Elsevier 2009:196-204
• 23. Strasser SM,Kwee A,Fijnheer R„ et al: Transient severe fetal heart rate abnomalities in pregnancy complicated by thrombotic thrombocytopenic purpura.Obstet Gynecol 111:517-521,2008
• 24. Salahaddin S,' Lee Y, Vadnais M, et al. Diagnostic utility of solubl fins-like tyrosine kinase 1 and soluble endoplin in hypertensive diseases of pregnancy. Am J obstet Gynecol 2007, 197: 28.e1-28e6
• 25. Vatten LJ, Eskild A, Nilsen Til, Jeanson S, Jenum PA, Staff AC. Changes in circulating level of angiogenic factors from the first to second trimester as a predictors of preeclampsia Am J, obstet Gynecol 2007: 196: 239el-e6 26. Maynard SE, Min JY, Merchan J et al. Excess sFLt-1 may contribute to endothelial dysfunction hypertension and proteinuria in women with preeclampsia J Clin invest 2003: 111: 649-58 27. Lindheimer MD.Unraveling the mysteries of preeclampsia.Am J Obstet Gynecol 2005;193:3-4
• 28. Leunen K, HallDR. Odendial HJ et al. The profile and compliications of women with placental abruption and intrauterin death . J Trop Pediatr 2003; 49: 231-234