Gebelerde Toxoplazma, Rubella, Sitomegalovirüs Taraması: Yapalım Mı?

Yıl 2021, Cilt: 10 Sayı: 4, 861 - 868, 29.12.2021

Deniz Kulaksız , Recep Erin , Kübra Baki Erin , Yeşim Bayoğlu Tekin

https://doi.org/10.37989/gumussagbil.801144

Cited By: 2

Öz

Perinatal veya konjenital enfeksiyonlar olarak da adlandırılan TORCH (Toksoplazma, Rubella, Sitomegalovirüs) enfeksiyonları fetüse bulaşarak teratojen etki gösterebilir.
Çalışmadaki amaç, Trabzon ilindeki gebelerde TORCH prevalansını saptamak ve maliyet analizi ile testin gerekliliğini araştırmaktır.
Çalışma retrospektif dosya araştırması şeklinde planlanmıştır. Ocak 2014 ve Aralık 2018 yılları arasında Trabzon Kanuni Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde ayaktan ya da yatarak tedavi almış gebe kadınlar dahil edilmiştir. Dosya taramasından yaş, gravida, parite, VKİ (vücut kitle indeksi), gebelik haftası, fetüs sayısı, özgeçmiş elde edilmiştir. Laboratuvar analizinden TOX IgG/IgM, RV IgG/IgM, CMV IgG/IgM pozitifliği ve avidite verileri elde edilmiştir. Yaş gruplarına göre anlamlılık için ki kare test uygulanmıştır.
Toplam 15985 test yapılmıştır. Anti TOX IgM pozitif olanların yaş ortalaması 27,31±3,45, anti rubella IgM pozitif olanların 28,23±4,53, anti CMV IgM pozitif olanların ki ise 29,01±4,76 idi. Verilerin analizinde gruplar arasında fark yoktu (p>0,05). Anti TOX IgG pozitifliği tüm testlerde %25,9 (n=4142), anti TOX IgM %1,53 (n=145), anti TOX IgGM +’lerde düşük avidite %13,87 (n=34), anti RV IgG %94,8 (n=15149), anti RV IgM %1 (n=161), anti RV IgGM +’lerde düşük avidite %14,2 (n=23), anti CMV IgG %76,1 (n=12163), anti CMV IgM %1 (n=165), anti CMV IgGM +’lerde düşük avidite %0,1 (n=19) bulunmuştur. Toplam test maliyetleri 554329 Türk lirası bulunmuştur.
Sonuç olarak, gebelikte ilk trimesterda anti rubella IgG taranmasını önerilmektedir. Hem maliyet hem de IgGM pozitif çıkanlardaki çok düşük doğrulama testi pozitifliği göz önüne alındığında toxoplazma ve CMV taranmasını önerilmemektedir.

Anahtar Kelimeler

TORCH, Maliyet-etkinlik, Doğu Karadeniz,

Toxoplasma, Rubella, Cytomegalovirus Screening in Pregnant Women: Should We Do It?

Öz

TORCH (Toxoplasma, Rubella, Cytomegalovirus) infections, also called perinatal or congenital infections, can transmit to the fetus and have a teratogenic effect.
The aim of the study is to determine the prevalence of TORCH in pregnant women in Trabzon and to investigate the necessity of the test with cost analysis.
The study was planned as a retrospective file research. Pregnant women who received outpatient or inpatient treatment at Trabzon Kanuni Training and Research Hospital Gynecology and Obstetrics Clinic between January 2014 and December 2018 were included. Age, gravida, parity, BMI (body mass index), gestational week, number of fetuses, and history were obtained from file scanning. TOX IgG/IgM, RV IgG/IgM, CMV IgG/IgM positivity and avidity data were obtained from laboratory analysis. Chi-square test was applied for significance according to age groups.
A total of 15985 tests were performed. The mean age of those with anti TOX IgM positive was 27.31±3.45 years, those with anti rubella IgM positive were 28.23±4.53 years and those with anti CMV IgM positive were 29.01±4.76 years. There was no difference between the groups in the analysis of the data (p>0.05). Anti TOX IgG positivity in all tests 25.9% (n=4142), anti TOX IgM 1.53% (n=145), low avidity in anti TOX IgGM + 13.87% (n=34), anti RV IgG 94.8% (n=15149), anti RV IgM 1% (n=161), low avidity in anti RV IgGM+ 14.2% (n=23), anti CMV IgG 76.1% (n=12163) ), anti CMV IgM 1% (n=165), low avidity 0.1% (n=19) in anti CMV IgGM +s. Total test costs were found to be 554329 Turkish liras.
In conclusion, it is recommended to screen for anti rubella IgG in the first trimester of pregnancy. Considering both the cost and the very low confirmatory test positivity in IgGM positives, screening for toxoplasma and CMV is not recommended.

Anahtar Kelimeler

TORCH, Cost-effectiveness, Eastern Black Sea

Kaynakça

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