Plasenta ve Umblikal Kord Özellikleri ile Fetal Distress Arasındaki İlişki

Yıl 2023, Cilt: 33 Sayı: 5, 562 - 568, 25.10.2023

Sevcan Sarıkaya , Emre Uysal , Abdurrahman Mert , Muslu Kazım Körez , Oğuzhan Günenc , Burhan Savaş , Seyran Coşar Elif Ceyda Serin

https://doi.org/10.54005/geneltip.1314279

Öz

Amaç: Çalışmamızda; plasenta kalınlığı ve ağırlığı, umblikal kord çapı ve uzunluğunun ve plasentanın kord insersiyo bölgesinin fetal distress ile ilişkisini ve bunun bebeğin doğum APGAR skoru ve kord kan gazı üzerindeki etkilerini araştırdık.
Gereç ve yöntem: Çalışmamızda hastanemizde doğum yapan, gestasyonel hastası 37+0- 41+6 hafta arasında olan, 18-45 yaş arasındaki hastaların verileri prospektif olarak kayıt altına alındı. Fetal distress nedeni ile sezaryen yapılan 200 hasta (Grup I) ve daha önce sezaryen ile doğum yapması nedeni ile elektif sezaryen planlanan 200 hasta (Grup II) olmak üzere toplam 400 hastanın verileri kayıt altına alındı, 15 hasta çalışma dışı bırakıldı, 385 hasta çalışmaya dahil edildi. Olguların demografik özellikleri, plasenta kalınılığı ve ağırlığı, umblikal kord çapı ve uzunluğu, umblikal kordun plasentaya insersiyo bölgesi, yenidoğanın cinsiyeti, birinci ve beşinci dakika Apgar skoru, ve umblikal kord kan gazı değerleri kaydedildi. Tüm parametreler her iki grup arasında karşılaştırıldı.
Bulgular: Her iki grup karşılaştırıldığında Grup I’deki anne yaşının (29.13 ± 5.20 vs. 25.67 ± 5.27, p<.001) ve body mass index (30.10 ± 4.20 vs. 27.15 ± 3.97, p<.001) değerinin Grup II’ den istatistiksel olarak daha düşük olduğu saptandı. Hemoglobin (11.83 ± 1.27 vs. 12.16 ± 1.41, p=.019) ve white blood cell (10.17 ± 2.37 vs. 10.76 ± 2.57, p=.020) değerinin ise Grup I’de Grup II’den daha yüksek olduğu görüldü. Plasenta ağırlığının (515 [IQR, 430 – 582.5] vs. 610 [IQR, 520 – 710], p<.001) ve kalınlığının (2.42 ± 0.91 vs. 2.72 ± 0.91, p<.001) Grup I hastalarda Grup II hastalara göre daha düşük olduğu görüldü. Grup I hastalarda umblikal kord uzunluğunun (24.02 ± 10.02 vs. 57.35 ± 13.95, p=.008) Grup II’den anlamlı olarak kısa olduğu görüldü.
Sonuç: Genç anne yaşı, düşük body mass index, kısa umblikal kord, düşük plasental ağırlık ve ince plasentanın fetal distress ile pozitif korelasyon gösterdiği saptanmıştır. Bu özellikleri taşıyan gebelerin fetal distress açısından daha dikkatli takip edilmesi, daha iyi perinatal ve neonatal sonuçlar için önem taşımaktadır.

Anahtar Kelimeler

Fetal distress, plasenta kalınlığı, plasenta ağırlığı, umblikal kord uzunluğu, umblikal kord çapı

Destekleyen Kurum

Çalışmamız Konya Şehir Hastanesi KAdın Hastalıkları ve Doğum kliniğinde yapılmış olup ek finansman kaynağı yoktur.

The Relationship Between Placenta and Umbilical Cord Characteristics and Fetal Distress

Öz

Aim: In our study, we investigated the relationship between placental thickness and weight, umbilical cord diameter and length, and placental cord insertion site with fetal distress, and its effects on the baby's APGAR score and cord blood gas.
Materials and methods: In our study, the data of the patients who gave birth in our hospital, whose gestational patient was between 37+0- 41+6 weeks, and between the ages of 18-45 were recorded prospectively. 385 patients (196 patients fetal distress and 189 patients elective cesarean section) were included in the study. Demographic characteristics, placental thickness and weight, umbilical cord diameter and length, insertion site of the umbilical cord into the placenta, newborn gender, first- and fifth-minute. Apgar score, and umbilical cord blood gas values were recorded. All parameters were compared between both groups.
Results: When both groups are compared, Maternal age (29.13 ± 5.20 vs. 25.67 ± 5.27, p<.001) and body mass index (30.10 ± 4.20 vs. 27.15 ± 3.97, p<.001) were found to be statistically lower in Group I than Group II. Placental weight (515 [IQR, 430 – 582.5] vs. 610 [IQR, 520 – 710], p<.001) and thickness (2.42 ± 0.91 vs. 2.72 ± 0.91, p<.001) were found to be statistically lower in Group I than Group II. In Group I patients, umbilical cord length (24.02 ± 10.02 vs. 57.35 ± 13.95, p=.008) was found to be significantly shorter than Group II.
Conclusion: Young maternal age, low body mass index, short umbilical cord, low placental weight and thin placenta were found to be positively correlated with fetal distress. More careful follow-up of pregnant women with these features in terms of fetal distress is important for better perinatal and neonatal outcomes.

Anahtar Kelimeler

placenta thickness, placenta weight, umbilical cord length, umbilical cord diameter, Fetal distress

Kaynakça

• Adesina KT, Ogunlaja OO, Aboyeji AP, Akande HJ, Adeniran AS, Olarinoye A, et al. Relationship between gross placental characteristics and perinatal outcome of low-risk singleton deliveries. Niger Postgrad Med J. 2016;23(4):191-5.
• Chang J-M, Mulgrew A, Salafia C. Characterizing placental surface shape with a high-dimensional shape descriptor. Applied Mathematics. 2012;3(9):954-68.
• Lakshmi C, Neelam S, Raghupathy NJIJDMS. Morphological studies of normal human placenta at different gestational periods. IOSR J Dent Med Sci. 2013;6(3):9-15.
• Perazzolo S, Hirschmugl B, Wadsack C, Desoye G, Lewis RM, Sengers BG. The influence of placental metabolism on fatty acid transfer to the fetus. Journal of lipid research. 2017;58(2):443-54.
• Boito S, Struijk PC, Ursem NT, Stijnen T, Wladimiroff JW. Umbilical venous volume flow in the normally developing and growth-restricted human fetus. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002;19(4):344-9.
• Elangovan M, Raviraj KJIJIR. Analysis of morphology and morphometry of human placenta and its clinical relevance. Imp J Interdiscip Res. 2016;2(8):1531-4.
• Patel S, Kumar RN, Contractor J, Vaniya VJIJRM. Morphological changes of placenta in pregnancy induced hypertension. Int J Res Med. 2016;5(1):104-7.
• Benirschke K, Burton GJ, Baergen RN. Anatomy and pathology of the placental membranes. pathology of the human placenta. 8 ed. New York: Springer; 2012. p. 249-307.
• Krakowiak P, Smith EN, de Bruyn G, Lydon-Rochelle MT. Risk factors and outcomes associated with a short umbilical cord. Obstetrics and gynecology. 2004;103(1):119-27.
• Barbieri C, Cecatti JG, Krupa F, Marussi EF, Costa JV. Validation study of the capacity of the reference curves of ultrasonographic measurements of the umbilical cord to identify deviations in estimated fetal weight. Acta Obstet Gynecol Scand Suppl 2008;87(3):286-91.
• Hanley ML, Ananth CV, Shen-Schwarz S, Smulian JC, Lai YL, Vintzileos AM. Placental cord insertion and birth weight discordancy in twin gestations. Obstetrics and gynecology. 2002;99(3):477-82.
• Simon LV, Hashmi MF, Bragg BN. APGAR Score. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Muhammad Hashmi declares no relevant financial relationships with ineligible companies. Disclosure: Bradley Bragg declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023.
• Vintzileos AM, Gaffney SE, Salinger LM, Kontopoulos VG, Campbell WA, Nochimson DJ. The relationships among the fetal biophysical profile, umbilical cord pH, and Apgar scores. Am J Obstet Gynecol MFM. 1987;157(3):627-31.
• GOLDABER KG, GILSTRAP III LCJCo, gynecology. Correlations Between Obstetric Clinical Events and Umbilical Cord Blood Acid—Base and Blood Gas Values. 1993;36(1):47-59.
• Meskele S, Mulu A, GebreMickael A, Ena L. Placental and Umbilical Cord Indices and Their Association with Fetal Distress in Hadiya Zone Public Hospitals, Southern Ethiopia: A Cross-Sectional Study. Int J Gen Med. 2021;14:10045-53.
• Soliriya V, Goyal M, Kachhawaha CJJPCH. Perinatal mortality and umbilical cord parameters: Is there any association. J Pregnancy Child Health. 2017;4(4):10-3.
• Rigano S, Bozzo M, Padoan A, Mustoni P, Bellotti M, Galan HL, et al. Small size-specific umbilical vein diameter in severe growth restricted fetuses that die in utero. Prenatal diagnosis. 2008;28(10):908-13.
• Raio L, Ghezzi F, Di Naro E, Franchi M, Maymon E, Mueller MD, et al. Prenatal diagnosis of a lean umbilical cord: a simple marker for the fetus at risk of being small for gestational age at birth. Ultrasound Obstet Gynecol. 1999;13(3):176-80.
• Balkawade NU, Shinde MA. Study of length of umbilical cord and fetal outcome: a study of 1,000 deliveries. J Obstet Gynaecol India. 2012;62(5):520-5.
• Udoh BE, Erim A, Anthony EJJoDMS. Sonographic assessment of umbilical cord diameter as an indicator of fetal growth and perinatal outcome. J Diagn Med Sonogr. 2021;37(1):41-5.
• Kingdom JC, Kaufmann P. Oxygen and placental villous development: origins of fetal hypoxia. Placenta. 1997;18(8):613-21; discussion 23-6.
• Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2013;346:f3443.
• Gaillard R, Eilers PH, Yassine S, Hofman A, Steegers EA, Jaddoe VW. Risk factors and consequences of maternal anaemia and elevated haemoglobin levels during pregnancy: a population-based prospective cohort study. Paediatr Perinat Epidemiol. 2014;28(3):213-26.
• von Tempelhoff GF, Velten E, Yilmaz A, Hommel G, Heilmann L, Koscielny J. Blood rheology at term in normal pregnancy and in patients with adverse outcome events. Clin Hemorheol Microcirc. 2009;42(2):127-39.
• Thorburn J, Drummond MM, Whigham KA, Lowe GD, Forbes CD, Prentice CR, et al. Blood viscosity and haemostatic factors in late pregnancy, pre-eclampsia and fetal growth retardation. Br J Obstet Gynaecol. 1982;89(2):117-22.
• Osman K, Özdemir SJKÜTFD. Fetal Morbiditeyi Öngörmede Umblikal Arter Kan pH’i ve Birinci Dakika APGAR Skorunun Değerleri. Kırıkkale Üni Tıp Derg2013;15(3):9-14.
• BLECHNER JNJCo, gynecology. Maternal—Fetal Acid—Base Physiology. Clin Obstet Gynecol. 1993;36(1):3-12.
• Nelson KB, Leviton A. How much of neonatal encephalopathy is due to birth asphyxia? Am J Dis Child. (1960). 1991;145(11):1325-31.
• van den Berg P, Schmidt S, Gesche J, Saling E. Fetal distress and the condition of the newborn using cardiotocography and fetal blood analysis during labour. Br J Obstet Gynaecol. 1987;94(1):72-5.
• Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. BMJ. 2010;340:c1471.
• Yeh P, Emary K, Impey L. The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51,519 consecutive validated samples. BJOG. 2012;119(7):824-31.
• Gordon A, Johnson JW. Value of umbilical blood acid-base studies in fetal assessment. J Reprod Med. 1985;30(4):329-36.