Abortus İmminensli ve Sağlıklı Gebe Kadınlarda Obstetrik ve Neonatal Sonuçların ve Subkoriyonik Hematomun Etkilerinin Karşılaştırılması

Yıl 2021, Cilt: 26 Sayı: 3, 296 - 301, 27.09.2021

Aysun Tekeli Taşkömür , Özlem Erten

https://doi.org/10.21673/anadoluklin.861511

Öz

Amaç: Bu çalışmada abortus imminensli (Aİ) kadınlarda ve sağlıklı kontrollerde obstetrik ve neonatal sonuçları ve subkoriyonik hematom (SH) varlığının etkilerini karşılaştırmak amaçlanmıştır.
Yöntem: Gebe kadınlara ait tıbbi veriler retrospektif olarak incelendi. Aİ tanılı 138 gebenin (çalışma grubu) obstetrik ve neonatal sonuçları, rastgele seçilmiş 138 sağlıklı kontrolün sonuçları ile karşılaştırıldı. Bu sonuçlar birinci trimesterde ultrasonografiyle tespit edilen SH varlığına göre de karşılaştırıldı.
Bulgular: Gruplar demografik açıdan homojendi. Çalışma grubunda ortalama bebek ağırlığı ve 1. dakika Apgar skoru daha düşük, düşük doğum ağırlıklı bebek oranı daha yüksekti. SH oranı çalışma grubunda istatistiksel olarak anlamlı biçimde daha yüksekken (p<0,05), iki grup arasında doğum haftası, erken doğum, postmatürite, doğum şekli, preeklampsi, plasental abrupsiyon ve 5. dakika Apgar skorları açısından anlamlı fark yoktu (p>0,05). Kontrol grubunda SH’li ve SH’siz kadınlar arasında obstetrik ve neonatal sonuçlar açısından anlamlı fark yoktu. Çalışma grubunda ise SH’siz kadınlara kıyasla SH’li kadınlarda 5. dakika Apgar skorları anlamlı biçimde (p=0,002) daha yüksekti.
Sonuç: Aİ, fetal kilo alımını ve iyilik halini etkileyerek düşük doğum ağırlıklı bebek ve düşük 1. dakika Apgar skoru ihtimalini artırabilir. Diğer risk faktörleri olmaksızın tek başına SH, sağlıklı gebelerde neonatal ve obstetrik sonuçlar üzerinde etkili görünmemektedir. Diğer risk faktörleri olmadığında konkomitan Aİ ve SH 5. dakika Apgar skorlarını olumlu etkileyebilir.

Anahtar Kelimeler

Abortus imminens, neonatal sonuçlar, obstetrik sonuçlar

A Comparison of Obstetric and Neonatal Outcomes and Subchorionic Hematoma Effects in Pregnant Women with Threatened Abortion and Healthy Controls

Öz

Aim: In this study, we aimed to compare the obstetric and neonatal outcomes and effects of subchorionichematoma (SH) in women with threatened abortion (TA) and healthy controls.
Methods: The medical records of pregnant women were retrospectively reviewed. The obstetric and neonatal outcomes in 138 pregnant women diagnosed with TA (study group) were compared with those in 138 randomly selected healthy controls. The outcomes were also compared according to SH presence as revealed by ultrasonography (USG) in the first trimester.
Results: The groups were demographically homogeneous. The mean infant weight and 1st-minute Apgar score were lower and the low-birth-weight infant rate was higher in the study group. The SH rate was statistically significantly higher in the study group (p<0.05), while there was no significant difference between the two groups in terms of birth week, preterm labor, postmaturity, delivery type, preeclampsia, placental abruption, and 5th-minute Apgar scores (p>0.05). In the control group, there was no significant difference between women with and without SH in terms of obstetric and neonatal outcomes. In the study group, the mean 5th-minute Apgar score was found to be significantly (p=0.002) higher in pregnant women with SH than in those without.
Conclusion: TA may increase the likelihood of a low-birth-weight infant and a low 1st-minute Apgar score by affecting fetal weight gain and well-being. SH alone without other risk factors does not appear to affect neonatal and obstetric outcomes in healthy pregnant women. Concomitant SH and TA without additional risk factors may positively affect 5th-minute Apgar scores.

Anahtar Kelimeler

neonatal outcomes, obstetric outcomes, threatened abortion

Kaynakça

• Farrell T, Owen P. The significance of extrachorionic membrane separation in threatened miscarriage. Br J Obstet Gynaecol. 1996;103(9):926–8.
• Saraswat L, Bhattacharya S, Maheshwari A, Bhattacharya S. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review. BJOG. 2010;117(3):245–57.
• Uerpairojkit B, Charoenvidhya D, Tannirandorn Y, Wacharaprechanont T, Manotaya S, Samritpradit P, et al. Sonographic findings in clinically diagnosed threatened abortion. J Med Assoc Thai. 2001;84(5):661–5.
• 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.
• Ozkaya E, Altay M, Gelişen O. Significance of subchorionic haemorrhage and pregnancy outcome in threatened miscarriage to predict miscarriage, preterm labour and intrauterine growth restriction. J Obstet Gynaecol. 2011;31(3):210–2.
• 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.
• Wijesiriwardana A, Bhattacharya S, Shetty A, Smith N, Bhattacharya S. Obstetric outcome in women with threatened miscarriage in the first trimester. Obstet Gynecol. 2006;107(3):557–62.
• Pawelec M, Pałczyński B, Krzemieniewska J, Karmowski M, Koryś J, Lątkowski K, et al. Initiation of preterm labor. Adv Clin Exp Med. 2013;22(2):283–8.
• Madhappan B, Kempuraj D, Christodoulou S, Tsapikidis S, Boucher W, Karagiannis V, et al. High levels of intrauterine corticotropin-releasing hormone, urocortin, tryptase, and interleukin-8 in spontaneous abortions. Endocrinology. 2003;144(6):2285–90.
• Ziganshin AU, Zefirova JT, Zefirova TP, Ziganshina LE, Hoyle CH, Burnstock G. Potentiation of uterine effects of prostaglandin F2{alpha} by adenosine 5'-triphosphate. Obstet Gynecol. 2005;105(6):1429–36.
• Ozdemirci S, Karahanoglu E, Esinler D, Gelisen O, Kaynakçıoğlu F. Influence of threatened miscarriage on pregnancy and early postpartum period: a case-control report. J Matern Fetal Neonatal Med. 2015;28(10):1186–9.
• Villa PM, Kajantie E, Räikkönen K, Pesonen AK, Hämäläinen E, Vainio M, et al. Aspirin in the prevention of pre-eclampsia in high-risk women: a randomised placebo-controlled PREDO trial and a meta-analysis of randomised trials. BJOG. 2013;120(1):64–74.
• Nicolaides KH. A model for a new pyramid of prenatal care based on the 11 to 13 weeks’ assessment. Prenat Diagn. 2011;31(1):3–6.
• Beta J, Akolekar R, Ventura W, Syngelaki A, Nicolaides KH. Prediction of spontaneous preterm delivery from maternal factors, obstetric history and placental perfusion and function at 11–13 weeks. Prenat Diagn. 2011;31(1):75–83.
• Jouppila P. Clinical consequences after ultrasonic diagnosis of intrauterine hematoma in threatened abortion. J Clin Ultrasound. 1985;13(2):107–11.
• Naert MN, Rodriguez AM, Khadraoui H, Naqvi M, Fox NS. Association between first-trimester subchorionic hematomas and adverse pregnancy outcomes after 20 weeks of gestation in singleton pregnancies. Obstet Gynecol. 2019;134(4):863–8.