FETAL HAREKETLERDE AZALMA ÖN TANISIYLA DOĞUM ÜNİTESİNE YATIRILAN GEBELERİN DEĞERLENDİRİLMESİ

Yıl 2015, Cilt: 5 Sayı: 1, 37 - 40, 27.02.2015

Ayla Aktulay Yaprak Engin Üstün Necati Hançerlioğulları Özlem Moraloğlu Büşra Demir Özlem Yörük

Öz

ÖZET
Amaç: Antenatal  takipleri  sırasında  veya  hastanemiz  acil  polikliniğine bebek hareketlerinde azalma şikayeti ile gelip, fetal hareketlerde azalma  ön tanısı ile Doğum Ünitesine yatırılan gebel- erin perinatal ve obstetrik sonuçlarının incelenmesi amaçlanmıştır.
Gereç ve yöntemler: Mayıs 2011-Mayıs 2012 tarihleri arsında Hastanemiz Doğum Ünitesi’ne fetal hareketlerde azalma ön tanısıyla yatırılan 36.hafta ve üzeri 396 gebe retrospektif olarak incelendi. Yüksek riskli gebeler çalışma dışı bırakıldı. Hastaların yaşı, gravida,  paritesi, vücut kütle indeksi, tam kan sayımı, vital bulguları ile doğum şekli ve perinatal sonuçlar kaydedildi.
Bulgular: Bir yıl içinde Doğum Ünitesi’ne yatan 14650 Hastanın 396 ‘nın (%2,70) fetal hareketlerde azalma ön tanısıyla yatırıldığı tespit edildi. Doğum ünitesine yatıp değerlendirilen 396 hastanın
143’ünün (%33,11) taburcu edildiği saptandı. Tüm yatan hasta grubunda 13447 doğum oldu. Prim- er sezaryen sayısı 2669 (%19,98) iken fetal hareketlerde azalma tanısıyla yatan grupta doğurtulan
233 gebede primer sezaryen oranı  %33,90 olarak tespit edildi.
Sonuç: Fetal hareketlerde azalma artmış sezaryen oranlarına neden olabilir.

Anahtar kelimeler: Fetal hareket; Fetal ölüm; Gebelik

ABSTRACT
Objective: The purpose of this study was to review the perinatal and obstetric outcome of pregnant women who had complaints of reduction in the fetal movements during their antenatal follow-up examinations or applied to the emergency service with this complaint and were admitted to the delivery unit with reduced fetal movement prediagnosis.
Materials and Methods: The records of 396 pregnancies (36 weeks and over), which were admitted to our hospitals delivery unit during May 2011-May 2012 period with reduced fetal movement prediagnosis, were reviewed retrospectively. High risk pregnancies were excluded from the study. Patient’s age, gravidas, parities, body mass index, complete blood count, vital functions, mode of delivery and perinatal results were recorded
Results: It was determined that 396 patients (2.70%) out of 14,650 patients admitted to the
Delivery Unit were admitted due to reduced fetal movement prediagnosis.
Of these 396 patients, 142 (33.11%) were discharged after examinations. There were 13,447 deliveries for the total admitted patient group. While the number of primary caesarean sections were 2,669 (19.98%) for this group, the primary caesarean frequency for the 233 pregnant women prediagnosed with reduced fetal movement was 33.90%.
Conclusion: Reduced fetal movement may be associated with increased cesarean section rate.

Key words: Fetal movement; Fetal death; Pregnancy

Anahtar Kelimeler

Fetal hareket, Fetal ölüm; Gebelik

Kaynakça

• Pearson JF, Weaver JB.Fetal activity and fetal wellbeing: an evaluation.Br Med J. 1976 May 29;1(6021):1305-7.
• Efkarpidis S, Alexopoulos E, Kean L, Liu D, Fay T. Case- control study of factors associated with intrauterine fetal deaths. Med Gen Med. 2004 May 27;6(2):53.
• Frİen JF, Arnestad M, Frey K, Vege A, Saugstad OD, Stray- Pedersen B. Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986-1995. Am J Obstet Gynecol. 2001 Mar;184(4):694-702.
• Warrander LK, Batra G, Bernatavicius G, Greenwood SL, Dutton P, Jones RL, Sibley CP, Heazell AE. Maternal perception of reduced fetal movements is associated with altered placental structure and function. PLoS One. 2012;7(4):e34851.
• Heazell AE, Frİen JF. Methods of fetal movement counting and the detection of fetal compromise. J Obstet Gynaecol. 2008 Feb;28(2):147-54.
• Warrander LK, Heazell AE. Identifying placental dysfunction in women with reduced fetal movements can be used to predict patients at increased risk of pregnancy complications. Med Hypotheses. 2011 Jan;76(1):17-20.
• Saastad E, Israel P, Ahlborg T, Gunnes N, Frİen JF.Fetal movement counting--effects on maternal-fetal attachment: a multicenter randomized controlled trial. Epub 2011 Sep 6.
• Erratum in: Birth. 2012 Mar;39(1):89
• Olesen AG, Svare JA. Decreased fetal movements: background, assessment, and clinical management. Acta Obstet Gynecol Scand. 2004 Sep;83(9):818-26.
• Mangesi L, Hofmeyr GJ.Fetal movement counting for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004909.
• Frİen JF, Heazell AE, Tveit JV, Saastad E, Fretts RC, Flenady V. Fetal movement assessment. Semin Perinatol. 2008;32(4):243-6.
• Grant A, Elbourne D, Valentin L, Alexander S. Routine formal fetal movement counting and risk of antepartum late death in normally formed singletons. Lancet. 1989;2(8659):345-9.
• Frİen JF.A kick from within--fetal movement counting and the cancelled progress in antenatal care. J Perinat Med. 2004;32(1):13-24.
• Flenady V, MacPhail J, Gardener G, Chadha Y, Mahomed K, Heazell A, Fretts R, Frİen F. Detection and management of decreased fetal movements in Australia and New Zealand: a survey of obstetric practice. Aust N Z J Obstet Gynaecol. 2009;49(4):358-63.
• Stacey T, Thompson JM, Mitchell EA, Ekeroma A, Zuccollo J, McCowan LM. Maternal perception of fetal activity and late stillbirth risk: findings from the Auckland Stillbirth Study. Birth. 2011;38(4):311-6.
• O’Sullivan O, Stephen G, Martindale E, Heazell AE Predicting poor perinatal outcome in women who present with decreased fetal movements.J Obstet Gynaecol. 2009;29(8):705-10.
• Rådestad I.Fetal movements in the third trimester-- Important information about wellbeing of the fetus.Sex Reprod Healthc. 2010;1(4):119-21.
• Winje BA, Saastad E, Gunnes N, Tveit JV, Stray-Pedersen B, Flenady V, Frİen JF. Analysis of ‘count-to-ten’ fetal movement charts: a prospective cohort study. BJOG. 2011;118(10):1229-38.
• Peat AM, Stacey T, Cronin R, McCowan LM. Maternal knowledge of fetal movements in late pregnancy. Aust N Z J Obstet Gynaecol. 2012;52(5):445-9.
• Kınas, M. G., Sezer, S. D., Yuksel, H., Odabası, A. R., & Ture, M. The Role Of Fetal Movement Amount On Predıctıng The Non-Stress Test Results. Journal Of Turkish Society Of Obstetrics And Gynecology. 2011; 8(4): 238-43.