Evaluation of the predictivity of antenatal screening test parameters in pregnant women who had stillbirth due to intrauterine fetal demise

Öz

Objective: It was aimed to evaluate the predictivity of antenatal screening test parameters of pregnant women who had stillbirth due to intrauterine fetal demise according to maternal age and gestational birth weeks by retrospectively analysis in our study. Material and Methods: This retrospective cohort study included a total of 394 pregnant women who had a stillbirth due to intrauterine fetal demise at 20 weeks of gestation or later at the University of Health Sciences, Ankara Dr. Zekai Tahir Burak Women Health Education and Research Hospital between January 1, 2017, and June 15, 2019. Patients' demographic characteristics, birth characteristics, and antenatal screening test (combined, triple test) parameters (nuchal transparency [NT], free beta-human coronic gonadotropin [β-hCG], plasma protein-A [PAPP-A], hCG, unconjugated estriol [uE3], serum alpha-fetoprotein [ΑFP] multiples of median [MoM] values) were compared in separate groups of under and above 35 years of age and 20-34 weeks and above 34 weeks of gestation. Additionally, the correlation of antenatal screening test parameters with gestational week was evaluated. Data analysis was carried out using the SPSS version 26.0 statistical software package. Kolmogorov-Smirnov, Mann-Whitney U and Pearson Chi-Square tests were used for statistical analyses. Correlation analysis was performed using Spearman's correlation test. A p-value of <0.05 was considered statistically significant. Results: There was no statistically significant difference between groups under and above 35 years of age in terms of antenatal test parameters MoM values, gestational week, mode of delivery, and birth weight (p=0.230, p=0.214, p=0.129, p=0.644, p=0.473, p=0.537, p=0.098 and p=0.154). There was no statistically significant difference between the groups of 20-34 weeks and above 34 weeks of gestation in terms of antenatal test parameters MoM values (p=0.761, p=0.061, p=0.602, p=0.179 and p=0.120). There was no statistically significant correlation between gestational birth week and the combined test β-hCG, PAPP-A, NT, triple test hCG, uE3 and AFP MoM values (r=0.034, p=0.763, r=-0.210, p=0.060, r=-0.083, p=0.464, r=-0.057, p=0.181 and r=0.164, p=0.120). Conclusion: Clinicians should be careful about adverse pregnancy outcomes in cases of first-trimester increased NT, low free β-hCG, and PAPP-A, and second-trimester increased AFP, hCG, and dimeric inhibin alpha. However, there is currently no definitive laboratory test that has been demonstrated to be useful for predicting stillbirth in clinical practice. The identifiable combination of serum markers does not perform as well as a screening test for stillbirth at this stage. There is a need for large cohort studies with standardized screening test parameters and results.

Anahtar Kelimeler

• Antenatal screening tests
• intrauterine fetal demise
• predictivity
• stillbirth

İntrauterin fetal ölüm nedeniyle ölü doğum gerçekleştiren gebe kadınlarda antenatal tarama testi parametrelerinin fetal ölüm üzerine olan prediktivitesinin değerlendirilmesi

Öz

Amaç: Çalışmamızda intrauterin fetal ölüm nedeniyle ölü doğum gerçekleştirmiş gebe kadınlara ait antenatal tarama testi parametrelerinin retrospektif incelenerek maternal yaş ve doğum haftalarına göre fetal ölüm üzerine olan prediktivitesinin değerlendirilmesi amaçlandı. Gereç ve yöntemler: Bu retrospektif kohort çalışmaya, 1 Ocak 2017-15 Haziran 2019 tarihleri arasında Sağlık Bilimleri Üniversitesi, Ankara Dr. Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi’nde 20. gebelik haftası ve üzerinde intrauterin fetal ölüm nedeniyle ölü doğum gerçekleştirmiş olan toplam 394 gebe kadın dahil edildi. Hastalara ait demografik özellikler, doğum karakteristikleri ve antenatal tarama testi (ikili, üçlü test) parametreleri (nukal saydamlık [NT], serbest beta insan koryonik gonadotropin [β-hCG], gebelikle ilişkili plazma protein-A [PAPP-A], hCG, ankonjuge östriol [uE3], serum alfa fetoprotein [ΑFP] ortalamanın katları [MoM] değerleri) 35 yaş altı ve üstü ile 20-34. ve 34 üzeri gebelik haftalarına göre ayrı ayrı gruplar şeklinde karşılaştırıldı. Ayrıca antenatal tarama test parametrelerinin doğum haftası ile korelasyonu değerlendirildi. Verilerin analizi SPSS 26.0 istatistik paket programı kullanılarak yapıldı. İstatistiksel analizlerde Kolmogorov-Smirnov, Mann-Whitney U ve Pearson Ki-Kare testleri kullanıldı. Korelasyon analizi Spearman testi ile yapıldı. p<0.05 istatistiksel olarak anlamlı kabul edildi. Bulgular: 35 yaş altı ve üstü gruplar arasında, antenatal test parametreleri MoM değerleri, doğum haftası, doğum şekli, doğum ağırlığı yönünden istatiksel anlamlı fark izlenmedi (p=0.230, p=0.214, p=0.129, p=0.644, p=0.473, p=0.537, p=0.098 ve p=0.154). 20-34. ve 34 üzeri gebelik haftalarına göre gruplar arasında, antenatal test parametreleri MoM değerleri yönünden istatiksel anlamlı fark izlenmedi (p=0.761, p=0.061, p=0.602, p=0.179 ve p=0.120). Doğum haftası ile ikili test β-hCG, PAPP-A, NT, üçlü test hCG, uE3 ve AFP MoM değerleri arasında istatistiksel anlamlı korelasyon izlenmedi (r=0.034, p=0.763, r=-0.210, p=0.060, r=-0.083, p=0.464, r=-0.057, p=0.181 ve r=0.164, p=0.120). Sonuç: İlk trimester NT artışı, serbest β-hCG ve PAPP-A düşüklüğü ile ikinci trimester ΑFP, hCG ve dimerik inhibin alfa artışı tespit edilen olgularda olumsuz gebelik sonuçları yönünden klinisyenler dikkatli olmalıdır. Ancak günümüzde ölü doğumun prediktivitesinde klinik pratikte faydası gösterilmiş kesin bir laboratuvar testi henüz bulunmamaktadır. Serum belirteçlerinin tanımlanabilir kombinasyonunun ölü doğum için bir tarama testi kadar iyi performansı şu aşamada gösterilememektedir. Standartlaştırılmış tarama testi parametreleri ve sonuçları ile büyük kohort çalışmalarına ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• antenatal tarama testleri
• intrauterin fetal ölüm
• ölü doğum
• prediktivite

Kaynakça

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