Öz
Amaç: Tersiyer referans hastanemizde, sonografik olarak ilk trimesterde subkoryonik hematom (SKH) bulgusu izlenen ve SKH bulgusu olmayan abortus imminens tanılı hastaların gebelik sonuçlarının karşılaştırılması amaçlandı.
Materyal ve Metod: Bu retrospektif kohort çalışmada Dr. Zekai Tahir Burak Hastanesi’nde 2017 ve 2018 yıllarında abortus imminens tanısı almış 450 hastanın kayıtları incelendi. Gebeliği hastanemizde sonlanmış olan (abortus, missed veya doğum şeklinde) ve tanı anında fetal kardiyak ativitesi pozitif olan, toplam 228 kayıta ulaşıldı. 228 abortus imminens tanılı hastanın 44’ünde subkoryonik hematom mevcuttu. Çalışmaya; 6-14 hafta arası gebeliği olan, abortus imminens kliniği ile başvurmuş, tekil gebeliği olan, fetal kalp atımı pozitif olan, sonografik değerlendirmesinde SKH görünümü izlenmiş ya da izlenmemiş kanama şikayeti olan hastalar dahil edildi. 14 haftadan büyük gebeliği olan, fetal kalp atımı negatif olan, abortus insipiens tanısı alan, habitüel abortus öyküsü olan, sistemik hastalığı olan gebeler, gebelik takibini ve doğumunu farklı bir merkezde yapmış olan hastalar çalışma dışı bırakıldı. SKH tanısı alan toplam 44 hastanın gebelik sürecindeki abortus oranları, preterm gebelik, erken membran rüptürü (PPROM), sezaryen ve vajinal doğum oranları SKH bulgusu olmayan abortus imminens tanılı hastaların sonuçlarıyla karşılaştırıldı. İstatistiksel analizler SSPSS (Inc; Chicago, IL, USA) versiyon 20.0 yazılımı kullanılarak yapıldı. Değişken verilerin dağılımında Kolmogrov-Simirnov, Shapiro-Wilk’s testi, sayısal verilerde student t-test ve Mann-Whitney U testi kullanıldı. p<0.05 istatistiksel olarak anlamlı kabul edildi.
Bulgular: SKH izlenen hastalarda gebelik sonlanma haftaları anlamlı şekilde daha erken haftalarda izlendi. Ortalama gebelik sonlanma haftaları SKH izlenmeyen hastalarda 31.9± 11.5, SKH izlenen hastalarda 23.4± 12.7 olarak görüldü. SKH izlenen hastalarda abortus, sezaryen, vajinal doğum oranları sırasıyla, % 40.9, % 22.7, % 22.7, SKH izlenmeyen hastalarda ise sırasıyla, % 21.7, % 3.3 ve % 50 idi.
Sonuç: Çalışmamızda, SKH izlenen hastalarda, kötü gebelik sonuçlarının literatürle uyumlu şekilde artmış olduğu görüldü. Prospektif ve daha geniş katılımlı çalışmalar, gebelik sonuçlarını daha net öngörmek adına önemli bilgiler sağlayacaktır.
Anahtar Kelimeler
Destekleyen Kurum
Yoktur
Proje Numarası
Yoktur
Teşekkür
Yoktur
Kaynakça
- 1. Weiss JL, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH et al. Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study. Am J Obstet Gynecol. 2004;190(3):745-50.
- 2. Farrell T, Owen P. The significance of extrachorionic membrane separation in threatened miscarriage. Br J Obstet Gynaecol. 1996;103(9):926-8.
- 3. Basama FM, Crosfill F. The outcome of pregnancies in 182 women with threatened miscarriage. Arch Gynecol Obstet. 2004;270(2):86-90.
- 4. Mantoni M, Pedersen JF. Intrauterine haematoma. An ultrasonic study of threatened abortion. Br J Obstet Gynaecol. 1981;88(1):47-51.
- 5. Maso G, D'Ottavio G, De Seta F, Sartore A, Piccoli M, Mandruzzato G. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005;105(2):339-44.
- 6. Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003;102(1):94-100.
- 7. Xiang L, Wei Z, Cao Y. Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review. PLoS One. 2014;9(11):e111676.
- 8. Palatnik A, Grobman WA. The relationship between first-trimester subchorionic hematoma, cervical length, and preterm birth. Am J Obstet Gynecol. 2015;213(3):403 e1-4.
- 9. Tuuli MG, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol. 2011;117(5):1205-12.
- 10. Windrim C, Athaide G, Gerster T, Kingdom JCP. Sonographic findings and clinical outcomes in women with massive subchorionic hematoma detected in the second trimester. J Obstet Gynaecol Can. 2011;33(5):475-9.
- 11. Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical significance of ultransonographically detected subchorionic hemorrhages. Am J Obstet Gynecol. 1996;174(3):996-1002.
- 12. Norman SM, Odibo AO, Macones GA, Dicke JM, Crane JP, Cahill AG. Ultrasound-detected subchorionic hemorrhage and the obstetric implications. Obstet Gynecol. 2010;116(2 Pt 1):311-5.
- 13. Benson CB, Doubilet PM, Cooney MJ, Frates MC, David V, Hornstein MD. Early singleton pregnancy outcome: effects of maternal age and mode of conception. Radiology. 1997;203(2):399-403.
- 14. Mandruzzato GP, D'Ottavio G, Rustico MA, Fontana A, Bogatti P. The intrauterine hematoma: diagnostic and clinical aspects. J Clin Ultrasound. 1989;17(7):503-10.
- 15. Heller HT, Asch EA, Durfee SM, Goldenson RP, Peters HE, Ginsburg ES, Doubilet PM, Benson CB. Subchorionic Hematoma: Correlation of Grading Techniques With First-Trimester Pregnancy Outcome. J Ultrasound Med. 2018;37(7):1725-32.
- 16. Abu-Yousef MM, Bleicher JJ, Williamson RA, Weiner CP. Subchorionic hemorrhage: sonographic diagnosis and clinical significance. AJR Am J Roentgenol. 1987;149(4):737-40.
- 17. Johns J, Jauniaux E. Threatened miscarriage as a predictor of obstetric outcome. Obstet Gynecol. 2006;107(4):845-50.
- 18. Asato K, Mekaru K, Heshiki C, Sugiyama H, Kinjyo T, Masamoto H, Aoki Y. Subchorionic hematoma occurs more frequently in in vitro fertilization pregnancy. Eur J Obstet Gynecol Reprod Biol. 2014;181:41-4.
- 19. Truong A, Sayago MM, Kutteh WH, Ke RW. Subchorionic hematomas are increased in early pregnancy in women taking low-dose aspirin. Fertil Steril. 2016;105(5):1241-6.
- 20. Ben-Haroush A, Yogev Y, Mashiach R, Meizner I. Pregnancy outcome of threatened abortion with subchorionic hematoma: possible benefit of bed-rest? Isr Med Assoc J. 2003;5(6):422-4.
- 21. Bennett GL, Bromley B, Lieberman E, Benacerraf BR. Subchorionic hemorrhage in first-trimester pregnancies: prediction of pregnancy outcome with sonography. Radiology. 1996;200(3):803-6.
The effect of subcorionic hematoma on pregnancy outcomes in patients diagnosed with abortus imminens
Öz
Aim: It was aimed to compare the pregnancy outcomes of patients diagnosed with abortus imminens who had sonographic findings in the first trimester with or without a subcorionic hematoma (SCH) in our tertiary reference hospital.
Materials and Methods: In this retrospective cohort study, records of 450 patients diagnosed with abortus imminens in 2017 and 2018 at Dr. Zekai Tahir Burak Hospital were examined. A total of 228 records were reached, in which pregnancy was terminated in our hospital (abortus, missed or birth) and fetal positive cardiac activity at the time of diagnosis. SCH was present in 44 of 228 patients diagnosed with abortus imminens. Patients at 6-14 weeks of gestation, admitted with abortus imminens clinic with a single pregnancy, fetal heartbeat positivity with or without SCH in the sonographic evaluation were included in the study. More than 14 weeks of pregnancy, fetal heartbeat negativity, diagnosed with abortus incipiens, a history of habitual abortion, systemic diseases, and patients who had gestational follow-up and delivery at a different center were excluded from the study. Abortion rates, preterm pregnancy, preterm premature rupture of membranes (PPROM), cesarean and vaginal delivery rates of 44 patients diagnosed with SCH were compared with the results of patients diagnosed without SCH findings. Statistical analyzes were performed using SSPSS (Inc; Chicago, IL, USA) version 20.0 software. Kolmogorov-Smirnov, Shapiro-Wilks tests were used in the distribution of variable data, student t-test and Mann-Whitney U tests were used in numerical data. p<0.05 was considered statistically significant.
Results: Gestational weeks of the terminations were significantly earlier in patients with SCH. Mean pregnancy termination weeks were 31.9 ± 11.5 in patients without SCH, and 23.4 ± 12.7 in patients with SCH. Abortion, cesarean and vaginal delivery rates were 40.9 %, 22.7 %, 22.7 %, respectively in patients with SCH and 21.7 %, 3.3 % and 50 %, respectively, in patients without SCH.
Conclusion: In our study, it was observed that adverse pregnancy outcomes increased in accordance with the literature in patients with SCH. Prospective and larger studies will provide important information to predict pregnancy outcomes more clearly.
Anahtar Kelimeler
Proje Numarası
Yoktur
Kaynakça
- 1. Weiss JL, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH et al. Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study. Am J Obstet Gynecol. 2004;190(3):745-50.
- 2. Farrell T, Owen P. The significance of extrachorionic membrane separation in threatened miscarriage. Br J Obstet Gynaecol. 1996;103(9):926-8.
- 3. Basama FM, Crosfill F. The outcome of pregnancies in 182 women with threatened miscarriage. Arch Gynecol Obstet. 2004;270(2):86-90.
- 4. Mantoni M, Pedersen JF. Intrauterine haematoma. An ultrasonic study of threatened abortion. Br J Obstet Gynaecol. 1981;88(1):47-51.
- 5. Maso G, D'Ottavio G, De Seta F, Sartore A, Piccoli M, Mandruzzato G. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005;105(2):339-44.
- 6. Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003;102(1):94-100.
- 7. Xiang L, Wei Z, Cao Y. Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review. PLoS One. 2014;9(11):e111676.
- 8. Palatnik A, Grobman WA. The relationship between first-trimester subchorionic hematoma, cervical length, and preterm birth. Am J Obstet Gynecol. 2015;213(3):403 e1-4.
- 9. Tuuli MG, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol. 2011;117(5):1205-12.
- 10. Windrim C, Athaide G, Gerster T, Kingdom JCP. Sonographic findings and clinical outcomes in women with massive subchorionic hematoma detected in the second trimester. J Obstet Gynaecol Can. 2011;33(5):475-9.
- 11. Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical significance of ultransonographically detected subchorionic hemorrhages. Am J Obstet Gynecol. 1996;174(3):996-1002.
- 12. Norman SM, Odibo AO, Macones GA, Dicke JM, Crane JP, Cahill AG. Ultrasound-detected subchorionic hemorrhage and the obstetric implications. Obstet Gynecol. 2010;116(2 Pt 1):311-5.
- 13. Benson CB, Doubilet PM, Cooney MJ, Frates MC, David V, Hornstein MD. Early singleton pregnancy outcome: effects of maternal age and mode of conception. Radiology. 1997;203(2):399-403.
- 14. Mandruzzato GP, D'Ottavio G, Rustico MA, Fontana A, Bogatti P. The intrauterine hematoma: diagnostic and clinical aspects. J Clin Ultrasound. 1989;17(7):503-10.
- 15. Heller HT, Asch EA, Durfee SM, Goldenson RP, Peters HE, Ginsburg ES, Doubilet PM, Benson CB. Subchorionic Hematoma: Correlation of Grading Techniques With First-Trimester Pregnancy Outcome. J Ultrasound Med. 2018;37(7):1725-32.
- 16. Abu-Yousef MM, Bleicher JJ, Williamson RA, Weiner CP. Subchorionic hemorrhage: sonographic diagnosis and clinical significance. AJR Am J Roentgenol. 1987;149(4):737-40.
- 17. Johns J, Jauniaux E. Threatened miscarriage as a predictor of obstetric outcome. Obstet Gynecol. 2006;107(4):845-50.
- 18. Asato K, Mekaru K, Heshiki C, Sugiyama H, Kinjyo T, Masamoto H, Aoki Y. Subchorionic hematoma occurs more frequently in in vitro fertilization pregnancy. Eur J Obstet Gynecol Reprod Biol. 2014;181:41-4.
- 19. Truong A, Sayago MM, Kutteh WH, Ke RW. Subchorionic hematomas are increased in early pregnancy in women taking low-dose aspirin. Fertil Steril. 2016;105(5):1241-6.
- 20. Ben-Haroush A, Yogev Y, Mashiach R, Meizner I. Pregnancy outcome of threatened abortion with subchorionic hematoma: possible benefit of bed-rest? Isr Med Assoc J. 2003;5(6):422-4.
- 21. Bennett GL, Bromley B, Lieberman E, Benacerraf BR. Subchorionic hemorrhage in first-trimester pregnancies: prediction of pregnancy outcome with sonography. Radiology. 1996;200(3):803-6.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Kadın Hastalıkları ve Doğum |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Proje Numarası | Yoktur |
| Yayımlanma Tarihi | 30 Eylül 2020 |
| Gönderilme Tarihi | 31 Mayıs 2020 |
| Kabul Tarihi | 8 Haziran 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 17 Sayı: 3 |
