İNTRAUTERİN ÖLÜ DOĞUM OLGULARINDA ÖNLENEBİLİR RİSK FAKTÖRLERİNİN BELİRLENMESİ

Öz

ÖZET
Amaç: Hastanemize başvuran 24 hafta ve üzeri gebeliklerden ölü doğum sıklığını, etyolojisini, yönetimini,
oluşabilecek komplikasyonları ve tedavilerini araştırıp, riskli gebelikleri saptamak.
Gereç ve Yöntemler: İzmir Tepecik Eğitim Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde
2010-2013 yılları arasında gerçekleşen toplam 43.042 doğumdan 514 ölü doğum olgusu retrospektif ola- rak incelendi. Anne yaşı, paritesi, ultrasona göre gebelik haftası, maternal sistemik hastalıkları, yenidoğan ağırlıkları ve cinsiyetleri, amniyotik sıvı volümleri, doğum şekilleri, sezaryen endikasyonları, postoperatif komplikasyonları, fetal anomalileri değerlendirildi.
Bulgular: Çalışmamızda ölü doğum oranı % 1.2 olarak bulunmuş ve ölü doğum etyolojisinde ilk sırayı izah edilemeyen olgular almıştır. Ölü doğum etyolojisinde ikinci sıklıkta preeklampsiye, üçüncü sıklıkta ise dekolman plesentaya rastlanmıştır. Çalışmamızda ölü bebeklerin kilo ortalamaları 1695 gr bulunmuş, or- talama gebelik haftası 32 hafta olarak değerlendirilmiştir. Ölü doğan bebeklerdeki malformasyonlar içinde en sık saptanan serebrospinal anomalilerdir. Fetal otopsi tanılarının dağılımlarına bakıldığında ilk sırayı
%45 oranı ile doğumsal anomaliler almış olup, doğumsal anomalilerin %15’inin serebrospinal anomaliler olduğu saptanmıştır.
Sonuç: Çalışmamızda ölü doğumların en sık nedeni etyolojisi belirlenemeyen olgular olmuştur. Bu çalış- manın sonuçları özellikle antenatal bakımı içeren primer önleyici sağlık programlarına yönelmeye katkı yapabilir. Birincil ve ikincil merkezlerde antenatal bakım hizmetlerinin arttırılması, yüksek riskli gebelikle- rin daha erken gebelik haftalarında belirlenmesi ve gerekli tıbbi önlemlerin alınması ile ölü doğum oranını azaltabilir.
Anahtar kelimeler: Ölü doğum; Prenatal bakım; Otopsi

ABSTRACT
Objective: To investigate the incidence, etiology, treatment types and complications during the manage-
ment of stillbirth born to mother over 24 weeks of gestational age.
Materials and Methods: Five hundred and fourteen stillbirths out of 43,042 delivery were reviewed ret- rospectively between 2010 and 2013 in Tepecik Research and Training Hospital, Izmir. Age and parity of mother, gestational week of fetus detected under ultrasonography, maternal systemic disease, fetal weight and gender, the volume of amnion fluid, type of delivery, postoperative complications during the management and fetal anomalies were assessed.
Results: Stillbirth rate was found as 1.2% and unknown etiology was detected as the most frequently seen reason of fetal death, followed by preeclampsia and ablatio placenta. The avarage fetal weight was 1695 gr and the average delivery week was 32 weeks of gestational age. The most common malformation was cerebrospinal malformations. When we investigated the classification of the diagnosis of fetal autopsy; fetal malformations took the first place (45%) and central nervous system malformations constituded
15% of them.
Conclusion: We found that the most common reason of stillbirth was unknown factors. The results of this study may contribute to targeting primary protective health program, including especially antenatal care. Stillbirth rates may be diminished by increasing antenatal care in primary and secondary health services, determining high risk pregnancies in early gestational weeks, and taking necessary medical measures. Key words: Stillbirth; Prenatal care; Autopsy

Anahtar Kelimeler

• Ölü doğum,Prenatal bakım; Otopsi

Öz

Objective: To investigate the incidence, etiology, treatment types and complications during the management of stillbirth born to mother over 24 weeks of gestational age. Materials and Methods: Five hundred and fourteen stillbirths out of 43,042 delivery were reviewed retrospectively between 2010 and 2013 in Tepecik Research and Training Hospital, Izmir. Age and parity of mother, gestational week of fetus detected under ultrasonography, maternal systemic disease, fetal weight and gender, the volume of amnion fluid, type of delivery, postoperative complications during the management and fetal anomalies were assessed. Results: Stillbirth rate was found as 1.2% and unknown etiology was detected as the most frequently seen reason of fetal death, followed by preeclampsia and ablatio placenta. The avarage fetal weight was 1695 gr and the average delivery week was 32 weeks of gestational age. The most common malformation was cerebrospinal malformations. When we investigated the classification of the diagnosis of fetal autopsy; fetal malformations took the first place (45%) and central nervous system malformations constituded 15% of them. Conclusion: We found that the most common reason of stillbirth was unknown factors. The results of this study may contribute to targeting primary protective health program, including especially antenatal care. Stillbirth rates may be diminished by increasing antenatal care in primary and secondary health services, determining high risk pregnancies in early gestational weeks, and taking necessary medical measures

Anahtar Kelimeler

• Stillbirth,Prenatal care; Autopsy

Kaynakça

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