Preterm eylem tanı ve tedavisi

Öz

Preterm doğum, dünya genelinde neonatal morbidite ve mortalitenin önde gelen nedenlerinden biridir. Dünya Sağlık Örgütü tarafından 37. gebelik haftasından önce gerçekleşen doğumlar preterm doğum olarak tanımlanmıştır. Küresel istatistiklere göre, her yıl yaklaşık 15 milyon bebek prematüre olarak doğmakta ve bu sayı dünya genelindeki doğumların yaklaşık %10’unu oluşturmaktadır. Türkiye’de ise 2022 yılında prematüre doğum oranı T.C. Sağlık Bakanlığı tarafından 2022 yılında %12,9 olarak bildirilmiştir. Preterm eylemin erken teşhisi ve uygun yönetimi, neonatal komplikasyonları önlemek açısından büyük önem taşımaktadır. İleri gebelik haftalarında doğan prematüre bebekler nispeten daha iyi prognoza sahipken, <28. gebelik haftasında doğan bebekler için mortalite ve uzun vadeli nörolojik sekeller riski oldukça yüksektir. Özellikle intraventriküler kanama, solunum sıkıntısı sendromu, nekrotizan enterokolit ve sepsis gibi ciddi komplikasyonlar, erken doğum ile ilişkilidir. Preterm eylem tanısında klinik değerlendirme, ultrasonografi ve biyokimyasal belirteçler önemli rol oynarken, tedavide antenatal kortikosteroidler, tokolitikler, antibiyotikler ve nöroprotektif yaklaşımlar uygulanmaktadır. Bununla birlikte, preterm doğumun önlenmesi ve yönetimi halen obstetrik pratiğin en büyük zorluklarından biridir. Bu derlemede, preterm eylemin etiyolojisi, patogenezi, risk faktörleri, tanı yöntemleri ve güncel tedavi yaklaşımları ele alınarak, güncel literatür doğrultusunda kapsamlı bir bakış sunmayı amaçlamaktadır.

Anahtar Kelimeler

• preterm doğum
• tokoliz
• servikal uzunluk
• fetal fibronektin
• serklaj
• antenatal kortikosteroid

Diagnosis and treatment of preterm labor

Öz

Preterm birth remains one of the leading causes of neonatal morbidity and mortality worldwide. The World Health Organization (WHO) defines preterm birth as delivery occurring before 37 weeks of gestation. According to global statistics, approximately 15 million babies are born prematurely each year, accounting for around 10% of total births worldwide. In Turkey, the preterm birth rate was reported to be 12.9% in 2022 (Turkish Ministry of Health, 2022). Early diagnosis and appropriate management of preterm labor are crucial for preventing neonatal complications. While preterm infants born at later gestational ages generally have a better prognosis, those born before 28 weeks of gestation face significantly higher risks of mortality and long-term neurological sequelae. Severe complications associated with preterm birth include intraventricular hemorrhage, respiratory distress syndrome, necrotizing enterocolitis, and sepsis. The diagnosis of preterm labor relies on clinical assessment, ultrasonography, and biochemical markers, while treatment strategies include antenatal corticosteroids, tocolytics, antibiotics, and neuroprotective interventions. Despite advances in perinatal medicine, the prevention and management of preterm birth remain major challenges in obstetric practice. This review aims to provide a comprehensive overview of the etiology, pathogenesis, risk factors, diagnostic methods, and current literature on preterm labor.

Anahtar Kelimeler

• preterm labor
• tocolytics
• cervical lenght
• fetal fibronectin
• cerclage
• antenatal corticosteroids

Kaynakça

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