The Effect Of First Trimester Screening Markers On Intrauterine Growth Retardation And On Poor Neonatal Outcome

Öz

Aim: Early identification of trisomy 21 can be achieved by investigating fetal nuchal translucency NT , free human chorionic gonadotropin-β free-βhCG and pregnancy-associated plasma protein PAPP-A levels in first trimester. With this test, perinatal risks such as other chromosomal anomalies, intrauterine growth retardation IUGR and preterm labor can be determined. Our aim was to investigate whether first trimester test markers were successful in predicting IUGR. In addition, another aim was to reveal using these markers whether success of prediction of poor pregnancy outcome in patients with IUGR.Material and Methods: This study was done in an university hospital, retrospectively, with two group IUGR and healthy groups . Patients in both groups were delivered between 36-41th gestational weeks and performed first trimester screening test.Results: A total of 184 pregnant women were reached, 85 were IUGR, while 99 were healthy pregnant control group. When the first trimester screening test parameters were compared, PAPP-A and free β-hCG were found to be statistically significant decline in the IUGR group compared with controls p=0.019, p=0.037, respectively . However only low PAPP-A level was found to be significant after age and smoking and weight correction was done statistically.Conclusion: In summary, the first trimester low serum PAPP-A level may indicate IUGR which may occur during the late period of pregnancy. None of the markers used in the first trimester screening test on the poor neonatal outcome were successful.

Anahtar Kelimeler

• Intrauterine growth retardation,first trimester screening test,- PAPP-A,β-hCG

Birinci Trimester Tarama Testi Belirteçlerinin İntrauterin Gelişme Geriliği İle İlişkisi ve Neonatal Sonuçları Üzerine Etkisi

Öz

Giriş: Birinci trimesterde fetal nuchal translucency NT , free human chorionic gonadotropin-β free-βhCG ve pregnancy-associated plasma protein-A PAPP-A değerlerini araştırarak, trizomi-21’in erken tanısında tanıma sağlanabilir. Bu test ile diğer kromozomal anomaliler, intrauterin gelişme geriliği IUGG ve preterm eylem gibi perinatal riskler de belirlenebilir. Amacımız, IUGG tanısı alıp birinci trimester tarama testlerine ulaşabildiğimiz gebelerin postpartum sonuçları ile test sonuçlarını karşılaştırarak, IUGG’ nin önceden tahmininin mümkün olup olmadığını araştırmaktır. Ayrıca yine bu markerleri kullanarak IUGG’li gebelerde kötü perinatal sonucun önceden tahmin edebilme başarısını ortaya koymaktır.Gereç ve Yöntemler: Bu çalışma retrospektif olarak 2 yıllık bir zaman diliminde, bir eğitim ve araştırma hastanesinde yapıldı. Veritabanı ve hasta dosyalarında tetkikler sonrası IUGG tanısı koyulan ve bunlardan birinci trimester tarama testlerine ulaşabildiğimiz, gebelik haftası 36-41 arasında doğum yapanlar çalışma grubunu, ayrıca sağlıklı gebeliğin ardından 36-41 haftalar arasında sağlıklı bebek dünyaya getiren ve tarama testlerine ulaşabildiğimiz gebeler de kontrol grubunu oluşturdu.Bulgular: Toplam 184 gebe bilgilerine ulaşıldı, 85’i IUGG iken, buna karşılık 99’i sağlıklı gebe kontrol grubu olarak değerlendirildi. Birinci trimester tarama testi parametreleri karşılaştırıldığında, ortalama PAPP-A değeri kontrol grubunda hasta grubuna göre daha yüksekti p=0.019 . Free β-hCG de kontrol grubunda daha yüksekti p=0.037 . Gruplar arasındaki kilo, yaş ve sigara farkı için gerekli düzeltmeler yapıldıktan sonra sadece PAPP-A anlamlı bulundu. Test belirteçlerinin IUGG’de kötü neonatal sonucu öngörme başarısı ise anlamsızdı.Sonuç: Özet olarak belirtirsek birinci trimester düşük serum PAPP-A seviyesi gebeliğin geç döneminde ortaya çıkabilecek IUGG’ni yüksek oranda önceden işaret edebilir. Kötü neonatal sonucu öngörmede ise birinci trimester tarama testinde kullanılan belirteçlerin hiçbiri başarılı olamadı.

Anahtar Kelimeler

• İntrauterin gelişme geriliği,birinci trimester tarama testi,PAPP-A,β-hCG

Kaynakça

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