Araştırma Makalesi
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İlk trimester tarama testindeki biyokimyasal parametrelerin maternal ve fetal morbiditeyi öngörmedeki değerinin araştırılması–Retrospektif Vaka-Kontrol Çalışması

Yıl 2023, , 28 - 35, 31.08.2023
https://doi.org/10.33713/egetbd.1139461

Öz

AMAÇ: Bu araştırma maternal serum gebelikle ilişkili plazma protein A, serbest beta human koryonik gonadotropin düzeylerinin obstetrik komplikasyonlar ile ilişkisini incelemek amacıyla yapılmıştır.
MATERYAL-METOD: Bu araştırma retrospektif vaka-kontrol çalışmasıdır. Araştırma Aydın Adnan Menderes Üniversitesi Hastanesi’nde Ocak 2015 ve Kasım 2016 tarihleri arasında yapılmıştır. Down sendromu taraması için 1. Trimester tarama belirteçleri ve ense kalınlığına bakılmıştır. Çalışma doğum sonrası down sendromu olmayan tekil 250 gebe ile yapılmıştır. Çoğul gebeliği olan ve fetal kromozomal anomalileri olan kadınlar çalışma dışı bırakılmıştır. Verilerin değerlendirilmesinde Ki-Kare testi, Fisher’s Exact test ve Continuity Correction (Yates) test kullanılmıştır.
BULGULAR: Gebelerin yaş ortalaması 29,52±6,17, gebelik haftası ortalaması 12,2±0,8’dir. Olguların pregnancy associated plasma protein A (PAPP-A) düzeyleri ortalaması 0,92±0,40 multiples of the median (MoM), Beta human chorionic gonadotrophin (ß-hCG) düzeyleri ortalaması 1,36±0,98 MoM nukal translüsensi (NT) MoM değerleri ortalaması 0,92±0,31 MoM’dir. Olguların %28,8’inde erken doğum tehdidi (EDT), %20’sinde gebelik yaşına göre küçük bebek (SGA), %18,8’inde gestasyonel diabetes mellitus (GDM), %15,6’sında fetal distress, %15,6’sında erken doğum eylemi, %14,4’sında intrauterin gelişme geriliği (IUGR), %12,8’inde oligohidramnios ve %12’sinde erken membran rüptürü (EMR) komplikasyonu geliştiği saptanmıştır. Maternal serum PAPP-A≤0,5 MoM değeri ile GDM, EDT, erken doğum, EMR, oligohidramnios, polihidramnios, IUGR, SGA ve preterm doğum gelişimi arasında istatiksel olarak anlamlı bir ilişki tespit edilmiştir. Çalışmamızda serbest ß-hCG için düzeltilmiş sınır değer ≥2,5 MoM olarak alınmış olup irdelediğimiz gebelik sonuçları ile anlamlı birliktelik saptanmamıştır.
SONUÇ: Birinci trimester tarama testi sonuçları kromozomal anomaliler ile birlikte birçok istenmeyen gebelik sonucu için erken dönemde uyarıcı ölçüt olarak kullanılarak hastaların erken tanı ve uygun yönetimi planlamak için yararlanılabilir.

Kaynakça

  • 1. Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH, Hankins G, Berkowitz RL, Merkatz I, Craigo SD, Timor-Tritsch IE, Carr SR, Wolfe HM, Vidaver J, D'Alton ME. 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). Am J Obstet Gynecol. 2004 Oct;191(4):1446-51. doi: 10.1016/j.ajog.2004.06.052. PMID: 15507981.
  • 2. Krantz D, Goetzl L, Simpson JL, Thom E, Zachary J, Hallahan TW, Silver R, Pergament E, Platt LD, Filkins K, Johnson A, Mahoney M, Hogge WA, Wilson RD, Mohide P, Hershey D, Wapner R; First Trimester Maternal Serum Biochemistry and
  • Fetal Nuchal Translucency Screening (BUN) Study Group. Association of extreme first-trimester free human chorionic gonadotropin-beta, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. Am J Obstet Gynecol. 2004 Oct;191(4):1452-8. doi: 10.1016/j.ajog.2004.05.068. PMID: 15507982.
  • 3. Westergaard JG, Sinosich MJ, Bugge M, Madsen LT, Teisner B, Grudzinskas JG. Pregnancy- associated plasma protein A in the prediction of early pregnancy failure. Am J Obstet Gynecol. 1983; 145: 67-9.
  • 4. Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester maternal serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG. 2000 Oct;107(10):1265-70. doi: 10.1111/j.1471-0528.2000.tb11618.x. PMID: 11028579.
  • 5. Pihl K, Sørensen TL, Nørgaard-Pedersen B, Larsen SO, Nguyen TH, Krebs L, Larsen T, Christiansen M. First-trimester combined screening for Down syndrome: prediction of low birth weight, small for gestational age and pre-term delivery in a cohort of non-selected women. Prenat Diagn. 2008 Mar;28(3):247-53. doi: 10.1002/pd.1946. PMID: 18302310.
  • 6. Spencer K, Cowans NJ, Molina F, Kagan KO, Nicolaides KH. First-trimester ultrasound and biochemical markers of aneuploidy and the prediction of preterm or early preterm delivery. Ultrasound Obstet Gynecol. 2008 Feb;31(2):147-52. doi: 10.1002/uog.5163. PMID: 17992705.
  • 7. Ananth CV, Getahun D, Peltier MR, Salihu HM, Vintzileos AM. Recurrence of spontaneous versus medically indicated preterm birth. Am J Obstet Gynecol. 2006 Sep;195(3):643-50. doi: 10.1016/j.ajog.2006.05.022. PMID: 16949395.
  • 8. Kim YM, Bujold E, Chaiworapongsa T, Gomez R, Yoon BH, Thaler HT, Rotmensch S, Romero R. Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes. Am J Obstet Gynecol. 2003 Oct;189(4):1063-9. doi: 10.1067/s0002-9378(03)00838-x. PMID: 14586356.
  • 9. Spencer CA, Allen VM, Flowerdew G, Dooley K, Dodds L. Low levels of maternal serum PAPP-A in early pregnancy and the risk of adverse outcomes. Prenat Diagn. 2008 Nov;28(11):1029-36. doi: 10.1002/pd.2116. PMID: 18925584.
  • 10. D'Antonio F, Rijo C, Thilaganathan B, Akolekar R, Khalil A, Papageourgiou A, Bhide A. Association between first-trimester maternal serum pregnancy-associated plasma protein-A and obstetric complications. Prenat Diagn. 2013 Sep;33(9):839-47. doi: 10.1002/pd.4141. Epub 2013 Jul 10. PMID: 23613261.
  • 11. Ranta JK, Raatikainen K, Romppanen J, Pulkki K, Heinonen S. Decreased PAPP-A is associated with preeclampsia, premature delivery and small for gestational age infants but not with placental abruption. Eur J Obstet Gynecol Reprod Biol. 2011 Jul;157(1):48-52. doi: 10.1016/j.ejogrb.2011.03.004. Epub 2011 Apr 8. PMID: 21482016.
  • 12. Goetzinger KR, Singla A, Gerkowicz S, Dicke JM, Gray DL, Odibo AO. The efficiency of first-trimester serum analytes and maternal characteristics in predicting fetal growth disorders. Am J Obstet Gynecol. 2009 Oct;201(4):412.e1-6. doi: 10.1016/j.ajog.2009.07.016. Epub 2009 Aug 28. PMID: 19716535.
  • 13. Savvidou MD, Syngelaki A, Muhaisen M, Emelyanenko E, Nicolaides KH. First trimester maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein A in pregnancies complicated by diabetes mellitus. BJOG. 2012 Mar;119(4):410-6. doi: 10.1111/j.1471-0528.2011.03253.x. PMID: 22324916.

Value of first trimester screening test biochemichal parameters in predicting maternal and fetal morbidity-Retrospektif Case-Control Study

Yıl 2023, , 28 - 35, 31.08.2023
https://doi.org/10.33713/egetbd.1139461

Öz

OBJECTIVE: Our study was conducted to examine the relationship between maternal serum pregnancy-related plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (ß-hCG) levels and obstetric complications.
MATERIAL-METHOD: This research is a retrospective case-control study. The research was carried out at Aydın Adnan Menderes University Hospital between January 2015 and November 2016. The study was conducted with 250 singleton pregnant women who did not have postpartum Down syndrome. Women with multiple pregnancies and fetal chromosomal abnormalities were excluded from the study. SPSS Statistics 22.0 program was used for statistical analysis.
RESULTS: The mean age of the pregnant women was 29.52±6.17, and the mean week of gestation was 12.2±0.8. The mean PAPP-A of the cases was 0.92±0.40 multiples of the median (MoM), the mean of ß-hCG was 1.36±0.98 MoM, and the mean nuchal translucency (NT) was 0.92±0.31 MoM. In the patients, 28.8% threatened preterm birth (TPL), 20% small for gestational age (SGA), 18.8% gestational diabetes mellitus (GDM), 15.6% fetal distress, 15.6% preterm labor, % 14.4% intrauterine fetal growth retardation (IUGR), 12.8% oligohydramnios and 12% premature rupture of membranes (EMR) were detected. A statistically significant correlation was found between maternal serum PAPP-A≤0.5 MoM and the development of GDM, TPL, preterm birth, PROM, oligohydramnios, polyhydramnios, IUGR, SGA, and preterm birth. In our study, the corrected cut-off value for free ß-hCG was taken as ≥2.5 MoM, and no significant association was found with the pregnancy outcomes we examined.
CONCLUSION: First-trimester screening test results can be a warning for unwanted pregnancy results.

Kaynakça

  • 1. Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH, Hankins G, Berkowitz RL, Merkatz I, Craigo SD, Timor-Tritsch IE, Carr SR, Wolfe HM, Vidaver J, D'Alton ME. 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). Am J Obstet Gynecol. 2004 Oct;191(4):1446-51. doi: 10.1016/j.ajog.2004.06.052. PMID: 15507981.
  • 2. Krantz D, Goetzl L, Simpson JL, Thom E, Zachary J, Hallahan TW, Silver R, Pergament E, Platt LD, Filkins K, Johnson A, Mahoney M, Hogge WA, Wilson RD, Mohide P, Hershey D, Wapner R; First Trimester Maternal Serum Biochemistry and
  • Fetal Nuchal Translucency Screening (BUN) Study Group. Association of extreme first-trimester free human chorionic gonadotropin-beta, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. Am J Obstet Gynecol. 2004 Oct;191(4):1452-8. doi: 10.1016/j.ajog.2004.05.068. PMID: 15507982.
  • 3. Westergaard JG, Sinosich MJ, Bugge M, Madsen LT, Teisner B, Grudzinskas JG. Pregnancy- associated plasma protein A in the prediction of early pregnancy failure. Am J Obstet Gynecol. 1983; 145: 67-9.
  • 4. Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester maternal serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG. 2000 Oct;107(10):1265-70. doi: 10.1111/j.1471-0528.2000.tb11618.x. PMID: 11028579.
  • 5. Pihl K, Sørensen TL, Nørgaard-Pedersen B, Larsen SO, Nguyen TH, Krebs L, Larsen T, Christiansen M. First-trimester combined screening for Down syndrome: prediction of low birth weight, small for gestational age and pre-term delivery in a cohort of non-selected women. Prenat Diagn. 2008 Mar;28(3):247-53. doi: 10.1002/pd.1946. PMID: 18302310.
  • 6. Spencer K, Cowans NJ, Molina F, Kagan KO, Nicolaides KH. First-trimester ultrasound and biochemical markers of aneuploidy and the prediction of preterm or early preterm delivery. Ultrasound Obstet Gynecol. 2008 Feb;31(2):147-52. doi: 10.1002/uog.5163. PMID: 17992705.
  • 7. Ananth CV, Getahun D, Peltier MR, Salihu HM, Vintzileos AM. Recurrence of spontaneous versus medically indicated preterm birth. Am J Obstet Gynecol. 2006 Sep;195(3):643-50. doi: 10.1016/j.ajog.2006.05.022. PMID: 16949395.
  • 8. Kim YM, Bujold E, Chaiworapongsa T, Gomez R, Yoon BH, Thaler HT, Rotmensch S, Romero R. Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes. Am J Obstet Gynecol. 2003 Oct;189(4):1063-9. doi: 10.1067/s0002-9378(03)00838-x. PMID: 14586356.
  • 9. Spencer CA, Allen VM, Flowerdew G, Dooley K, Dodds L. Low levels of maternal serum PAPP-A in early pregnancy and the risk of adverse outcomes. Prenat Diagn. 2008 Nov;28(11):1029-36. doi: 10.1002/pd.2116. PMID: 18925584.
  • 10. D'Antonio F, Rijo C, Thilaganathan B, Akolekar R, Khalil A, Papageourgiou A, Bhide A. Association between first-trimester maternal serum pregnancy-associated plasma protein-A and obstetric complications. Prenat Diagn. 2013 Sep;33(9):839-47. doi: 10.1002/pd.4141. Epub 2013 Jul 10. PMID: 23613261.
  • 11. Ranta JK, Raatikainen K, Romppanen J, Pulkki K, Heinonen S. Decreased PAPP-A is associated with preeclampsia, premature delivery and small for gestational age infants but not with placental abruption. Eur J Obstet Gynecol Reprod Biol. 2011 Jul;157(1):48-52. doi: 10.1016/j.ejogrb.2011.03.004. Epub 2011 Apr 8. PMID: 21482016.
  • 12. Goetzinger KR, Singla A, Gerkowicz S, Dicke JM, Gray DL, Odibo AO. The efficiency of first-trimester serum analytes and maternal characteristics in predicting fetal growth disorders. Am J Obstet Gynecol. 2009 Oct;201(4):412.e1-6. doi: 10.1016/j.ajog.2009.07.016. Epub 2009 Aug 28. PMID: 19716535.
  • 13. Savvidou MD, Syngelaki A, Muhaisen M, Emelyanenko E, Nicolaides KH. First trimester maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein A in pregnancies complicated by diabetes mellitus. BJOG. 2012 Mar;119(4):410-6. doi: 10.1111/j.1471-0528.2011.03253.x. PMID: 22324916.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi
Bölüm Orijinal Araştırma
Yazarlar

İsa Kaplan 0000-0002-0861-319X

Erken Görünüm Tarihi 31 Ağustos 2023
Yayımlanma Tarihi 31 Ağustos 2023
Kabul Tarihi 21 Mart 2023
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

EndNote Kaplan İ (01 Ağustos 2023) İlk trimester tarama testindeki biyokimyasal parametrelerin maternal ve fetal morbiditeyi öngörmedeki değerinin araştırılması–Retrospektif Vaka-Kontrol Çalışması. Ege Tıp Bilimleri Dergisi 6 2 28–35.

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