genel tıp derg

Genel Tıp Dergisi

2602-3741

Selçuk Üniversitesi

10.54005/geneltip.1741350

Clinical Sciences (Other)

Klinik Tıp Bilimleri (Diğer)

ERKEN MEMBRAN RÜPTÜRÜ İLE KOMPLİKE OLMUŞ GEBELİKLERDE NST BULGULARININ PERİNATAL SONUÇLARA ETKİSİ

The Effect of Non-Stress Test Results on Perinatal Outcomes in Expectantly Managed Pregnancies Complicated by Premature Rupture of Membranes

https://orcid.org/0000-0003-1767-2383

Şimşekler

Tuğçehan

Konya şehir hastanesi

https://orcid.org/0000-0002-7463-9101

Kulhan

Nur Gözde

Konya Şehir Hastanesi

https://orcid.org/0009-0000-0815-3237

Savaş

Burhan

Konya Şehir Hastanesi

https://orcid.org/0000-0002-3383-2837

Doğru

Şükran

Konya Şehir Hastanesi

https://orcid.org/0009-0004-3209-5881

Şimşekler

Mustafa Osman

NECMETTİN ERBAKAN ÜNİVERSİTESİ, MERAM TIP FAKÜLTESİ

https://orcid.org/0000-0003-4373-5245

Günenc

Oğuzhan

Konya Şehir Hastanesi

https://orcid.org/0000-0003-0008-2205

Geyik Bayman

Melike

Konya Şehir Hastanesi

04 06 2026

36 2026 1 6 07 13 2025 10 27 2025

1990

Genel Tıp Dergisi

Amaç: Bu çalışmada, erken membran rüptürü (EMR) ile komplike olmuş ve bekleme-izlem yaklaşımı ile takip edilen gebeliklerde nonstres test (NST) bulgularının perinatal sonuçlara etkisinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Retrospektif olarak planlanan çalışmaya, Ocak 2018 – Ocak 2024 tarihleri arasında Konya Şehir Hastanesi’ne 26–34. gebelik haftaları arasında preterm erken membran rüptürü (PEMR) tanısı ile başvuran gebeler dahil edilmiştir. Hastalara ait veriler; gebelik haftası, anne yaşı, gravida, parite ve eşlik eden hastalıklar açısından incelenmiştir. NST sonuçları, NICHD 2008 kılavuzuna göre üç kategoriye ayrılmıştır. Çalışmaya toplam 96 hasta dahil edilmiştir. Bunların 68’i NST Kategori 1, 4’ü NST Kategori 2 ve 24’ü NST Kategori 3 grubunda yer almıştır. Kategori 2 grubunda yalnızca 4 olgu bulunduğundan, istatistiksel anlamlılık sağlanamayacağı için bu grup analizlere dahil edilmemiştir. Bu nedenle karşılaştırmalar yalnızca Kategori 1 (n=68) ve Kategori 3 (n=24) grupları arasında yapılmıştır. Anormal Doppler bulgusu olanlar, fetal anomali veya intrauterin gelişme geriliği saptanan olgular çalışma dışı bırakılmıştır. Perinatal sonuçlar; doğum ağırlığı, kan gazı parametreleri, Apgar skorları, yenidoğan yoğun bakım (YYBÜ) yatış oranı, YYBÜ’de kalış süresi ve neonatal mortalite oranları kaydedilerek değerlendirilmiştir.Bulgular: Çalışmamızda anlamlı fark gösteren parametreler kan gazı analizinde pH ve baz açığıdır. pH, Kategori 1’de 7,36, Kategori 3’te 7,30 olarak bulunmuş (p = 0,003), baz açığı ise Kategori 3’te anlamlı olarak daha düşük saptanmıştır (-3,90’a karşı -2,27; p = 0,028). Ortalama 1. dakika Apgar skoru Kategori 1’de 7,64; Kategori 3’te 7,33’tür (p = 0,253). Ortalama 5. dakika skorları sırasıyla 8,72 ve 8,45 bulunmuştur (p =0,306).Neonatal ölüm Kategori 1’de 3 (%4,4), Kategori 3’te ise 1 (%4,2) olguda gerçekleşmiş olup fark anlamlı değildir. YYBÜ’ye yatış oranı Kategori 1’de %58,8, Kategori 3’te %66,7’dir.Sonuç: NST, fetal iyilik halinin değerlendirilmesinde yararlı bir yöntem olsa da PEMR olgularında perinatal sonuçları öngörmedeki etkinliği sınırlıdır. Doğum kararının yalnızca NST bulgularına dayandırılması gereksiz erken doğumlara yol açabileceğinden, klinik değerlendirme çok yönlü yapılmalıdır. PEMR’ye eşlik eden gebeliklerde bireyselleştirilmiş bir yönetim stratejisi benimsenmeli vebu sonuçların doğrulanması için ileri çalışmalara ihtiyaç vardır.

Aim: This study aimed to evaluate the impact of nonstress test (NST) findings on perinatal outcomes in pregnancies complicated by premature rupture of membranes (PROM) managed expectantly.Materials and Methods: This retrospective study included pregnant women with preterm premature rupture of membranes (PPROM) between 26 and 34 weeks of gestation who were admitted to Konya City Hospital from January 2018 to January 2024.Patient data, including gestational age, maternal age, gravidity, parity, and comorbidities, were analyzed. NST results were classified into three categories based on the NICHD 2008 guidelines. A total of 96 patients were included in the study. Among them, 68 were classified as NST Category 1, 4 as NST Category 2, and 24 as NST Category 3. Since only four cases were identified in Category 2, this group was excluded from the analyses due to the inability to achieve statistical significance. Therefore, comparisons were conducted solely between Category 1 (n=68) and Category 3 (n=24) groups. Cases with abnormal Doppler findings, fetal anomalies, or intrauterine growth restriction were excluded. Perinatal outcomes were evaluated by recording birth weights, blood gas parameters, Apgar scores, NICU admission rates, NICU stay duration, and neonatal mortality rates.Results: In our study, the parameters that demonstrated statistically significant differences in blood gas analysis were pH and base excess. The pH was 7.36 in Category 1 and 7.30 in Category 3 (p =0.003), while base excess was found to be significantly lower in Category 3 compared to Category 1 (-3.90 vs. -2.27; p = 0.028). The mean 1-minute Apgar scores were 7.64 for Category 1 and 7.33 for Category 3 (p = 0.253), while the mean 5-minute scores were 8.72 and 8.45, respectively (p = 0.306). There were 3 neonatal deaths (4.4%) in Category 1 and 1 death (4.2%) in Category 3; no significant difference was observed. NICU admission rates were 58.8% for Category 1 and 66.7% for Category 3.Conclusion: Although NST is a useful method for assessing fetal well-being, its ability to predict perinatal outcomes in PPROM cases is limited. Since basing delivery decisions solely on NST findings may lead to unnecessary preterm births, clinical evaluation should be comprehensive and multidisciplinary. In pregnancies complicated by PPROM, an individualized management strategy should be adopted, and further studies are warranted to validate these findings.

Non-Stress Test (NST) Apgar Score preterm premature rupture of membranes(PPROM)

Erken Membran Rüptürü Non-Stres Test Apgar skoru

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