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

Yıl 2021, , 292 - 298, 31.08.2021

Seyit Ahmet Erol , Orhan Altınboğa , Atakan Tanacan , Ali Çağlar , Yaprak Ustun , A. Seval Özgü-erdinç

https://doi.org/10.20492/aeahtd.912940

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

Destekleyen Kurum

Bulunmamaktadır

Proje Numarası

Bulunmamaktadır

Teşekkür

Bulunmamaktadır

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

Proje Numarası

Bulunmamaktadır

Kaynakça

• 1. Management of Stillbirth: Obstetric Care Consensus No, 10. Obstetrics and gynecology. 2020;135(3):e110-e32.
• 2. World Health Organization (WHO). Stillbirths. https://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en/ (Accessed on March 09, 2020).
• 3. Centers for Disease Control and Preventation, What is Stillbirth? https://www.cdc.gov/ncbddd/stillbirth/facts.html (Accessed on February 25, 2020).
• 4. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England). 2016;388(10053):1725-74.
• 5. MBRRACE-UK Perinatal Mortality Surveillance Report, UK Perinatal Deaths for Births from January to December 2018 https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/perinatal-surveillance-report-2018/MBRRACE-UK_Perinatal_Surveillance_Report_2018_-_final_v3.pdf (Accessed on December, 2020).
• 6. Dongarwar D, Aggarwal A, Barning K, Salihu HM. Trends in Stillbirths and Stillbirth Phenotypes in the United States: An Analysis of 131.5 Million Births. International journal of MCH and AIDS. 2020;9(1):146-8.
• 7. Reinebrant HE, Leisher SH, Coory M, Henry S, Wojcieszek AM, Gardener G, et al. Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG : an international journal of obstetrics and gynaecology. 2018;125(2):212-24.
• 8. Aminu M, Bar-Zeev S, van den Broek N. Cause of and factors associated with stillbirth: a systematic review of classification systems. Acta obstetricia et gynecologica Scandinavica. 2017;96(5):519-28.
• 9. Hoyert DL, Gregory EC. Cause of Fetal Death: Data From the Fetal Death Report, 2014. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2016;65(7):1-25.
• 10. Groen H, Bouman K, Pierini A, Rankin J, Rissmann A, Haeusler M, et al. Stillbirth and neonatal mortality in pregnancies complicated by major congenital anomalies: Findings from a large European cohort. Prenatal diagnosis. 2017;37(11):1100-11.
• 11. Starikov R, Dudley D, Reddy UM. Stillbirth in the pregnancy complicated by diabetes. Current diabetes reports. 2015;15(3):11.
• 12. Townsend R, Manji A, Allotey J, Heazell A, Jorgensen L, Magee LA, et al. Can risk prediction models help us individualise stillbirth prevention? A systematic review and critical appraisal of published risk models. BJOG : an international journal of obstetrics and gynaecology. 2021;128(2):214-24.
• 13. Conde-Agudelo A, Bird S, Kennedy SH, Villar J, Papageorghiou AT. First- and second-trimester tests to predict stillbirth in unselected pregnant women: a systematic review and meta-analysis. BJOG : an international journal of obstetrics and gynaecology. 2015;122(1):41-55.
• 14. Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH, et al. First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial). American journal of obstetrics and gynecology. 2004;191(4):1446-51.
• 15. Hui D, Okun N, Murphy K, Kingdom J, Uleryk E, Shah PS. Combinations of maternal serum markers to predict preeclampsia, small for gestational age, and stillbirth: a systematic review. Journal of obstetrics and gynaecology Canada : JOGC. 2012;34(2):142-53.
• 16. Gomes MS, Carlos-Alves M, Trocado V, Arteiro D, Pinheiro P. Prediction of adverse pregnancy outcomes by extreme values of first trimester screening markers. Obstetric medicine. 2017;10(3):132-7.
• 17. MacDorman MF, Gregory EC. Fetal and Perinatal Mortality: United States, 2013. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2015;64(8):1-24.
• 18. Jelliffe-Pawlowski LL, Baer RJ, Blumenfeld YJ, Ryckman KK, O'Brodovich HM, Gould JB, et al. Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth. BJOG : an international journal of obstetrics and gynaecology. 2015;122(11):1484-93.
• 19. Spencer K, Cowans NJ, Avgidou K, Nicolaides KH. First-trimester ultrasound and biochemical markers of aneuploidy and the prediction of impending fetal death. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2006;28(5):637-43.
• 20. Cignini P, Maggio Savasta L, Gulino FA, Vitale SG, Mangiafico L, Mesoraca A, et al. Predictive value of pregnancy-associated plasma protein-A (PAPP-A) and free beta-hCG on fetal growth restriction: results of a prospective study. Archives of gynecology and obstetrics. 2016;293(6):1227-33.
• 21. Goetzl L, Krantz D, Simpson JL, Silver RK, Zachary JM, Pergament E, et al. Pregnancy-associated plasma protein A, free beta-hCG, nuchal translucency, and risk of pregnancy loss. Obstetrics and gynecology. 2004;104(1):30-6.
• 22. Dugoff L, Hobbins JC, Malone FD, Vidaver J, Sullivan L, Canick JA, et al. Quad screen as a predictor of adverse pregnancy outcome. Obstetrics and gynecology. 2005;106(2):260-7.
• 23. Smith GC, Shah I, White IR, Pell JP, Crossley JA, Dobbie R. Maternal and biochemical predictors of antepartum stillbirth among nulliparous women in relation to gestational age of fetal death. BJOG : an international journal of obstetrics and gynaecology. 2007;114(6):705-14.
• 24. Yaron Y, Cherry M, Kramer RL, O'Brien JE, Hallak M, Johnson MP, et al. Second-trimester maternal serum marker screening: maternal serum alpha-fetoprotein, beta-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome. American journal of obstetrics and gynecology. 1999;181(4):968-74.
• 25. Dugoff L. First- and second-trimester maternal serum markers for aneuploidy and adverse obstetric outcomes. Obstetrics and gynecology. 2010;115(5):1052-61.
• 26. Heazell AE, Hayes DJ, Whitworth M, Takwoingi Y, Bayliss SE, Davenport C. Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants. The Cochrane database of systematic reviews. 2019;5(5):Cd012245.
• 27. Fadiloglu E, Tanacan A, Unal C, Beksac MS. Evaluation and Management of Women who Have Experienced Stillbirth in Their Previous Pregnancies. Gynecology Obstetrics & Reproductive Medicine. 2020(Article in Press):1-4.
• 28. Mazer Zumaeta A, Wright A, Syngelaki A, Maritsa VA, Da Silva AB, Nicolaides KH. Screening for pre-eclampsia at 11-13 weeks' gestation: use of pregnancy-associated plasma protein-A, placental growth factor or both. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2020;56(3):400-7.
• 29. Sapantzoglou I, Wright A, Arozena MG, Campos RV, Charakida M, Nicolaides KH. Ophthalmic artery Doppler in combination with other biomarkers in prediction of pre-eclampsia at 19-23 weeks' gestation. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2021;57(1):75-83.