‘18-24 HAFTA UTERİN ARTER DOPPLER ULTRASONOGRAFİSİNDE PULSATİLİTE İNDEKSİNİN VE DİYASTOLİK ÇENTİK VARLIĞININ PREEKLAMPSİ ÖNGÖRÜSÜNDEKİ ÖNEMİ’

Öz

Amaç: İkinci trimester uterin arter pulsatilite indeksi (Pİ) değerinin ve diastolik çentik varlığının primigravid, düşük riskli gebe hastalarda preeklampsi öngörüsündeki önemini saptamaktır. Gerekçeler ve Yöntem: Primipar, tekil, 18-24 haftalar arası olan ve bilinen sistemik hastalığı, fetal yapısal kromozomal anormalliği, uterin anomalisi olmayan 244 gebe hasta çalışmaya dâhil edildi. Doppler ölçümleri transabdominal olarak yapıldı. Uterin arter Pİ değeri ve diastolik çentik varlığı not edildi. Daha önce normotansif olan bir gebede, 20. gebelik haftası ve sonrasında yeni başlayan hipertansiyon (> 140/90 mmHg) ve proteinüri (24 saatlik idrarda 300 mg ve üzeri), proteinüri yokluğunda hipertansiyona eşlik eden sistemik bulguların bulunması preeklampsi olarak değerlendirildi. 32 gebelik haftası öncesi preeklampsi gelişmesi erken preeklampsi olarak tanımlandı. Bulgular: Preeklampsi gözlenen 15 gebenin ortalama Pİ değeri (1,51), preeklampsi gözlenmeyen gebelerinkinden (0,89) anlamlı olarak yüksek bulundu (p<0,001). Preeklampsi için duyarlılığı ve özgüllüğü en yüksek olan eşik değer Pİ 1,13 olarak hesaplandı. Çentik gözlenen gebelerde preeklampsi ve erken preeklampsi gelişme oranı, çentik negatif olan gebelere göre anlamlı olarak artmıştı (p<0,001). Preeklampsi gözlenen 15 gebenin 13’ünde iki taraflı, ikisinde ise tek taraflı çentik pozitifti. Sonuç: Çentik pozitifliği ile preeklampsi riski artmakla birlikte, tek taraflı çentik pozitifliği olan gebelerin sadece ikisinde preeklampsi gelişmiş olması ortalama Pİ’nin eşik değer olan 1,13’ten düşük olması ile ilişkili olabileceğini düşündürmüştür. İki taraflı çentik pozitifliği olan gebelerde ise ortalama Pİ değerinin 1,13 eşik değerinden yüksek olması, bu grup hastalarda preeklampsinin daha sık gözlenmesini açıklamaktadır. Sonuç olarak, iki taraflı çentik pozitifliği olan gebelerin Pİ değeri 1,13’ten yüksekse, preeklampsi açısından çok yakından takip edilmesi gerekmektedir.

Anahtar Kelimeler

• Diyastolik çentik
• Uterin arter doppleri
• Preeklampsi
• Pulsatilite indeksi

THE UTILITY OF PULSATILITY INDEX AND DIASTOLIC NOTCH PRESENCE IN UTERINE ARTERY DOPPLER ULTRASOUND BETWEEN 18-24 WEEKS FOR PREEKLAMPSIA PREDICTION’

Öz

Aim: To determine second-trimester uterine artery pulsatility index (UA-PI) values and diastolic notch (DN) presences in primigravid, low-risk pregnant women for preeclampsia (PE) prediction. Matherials and Methods: We studied prospectively primigravid, pregnant women between 18 and 24 weeks of gestation who were admitted for routine prenatal care. An ultrasound examination that included measurements of the UA-PI and DN presence was performed and pregnancy outcomes were evaluated. Results: In total 244 primigravid pregnant women were included this study, and 15 (6,1 %) developed PE. When Preeclampsia positive (PEP) group and the preeclampsia negative (PEN) group compared, there was no difference in demographic data. PEP group mean UA-PI value was significantly higher (p< 0,01) when mean time of the delivery week (p< 0,01) and fetal birth weight (p< 0,01) were significantly lower than PEN group. DN was negative (NN) in 163 (66,8 %) pregnant women, and found positive (NP) in 81 (33,2%) pregnant women. NP group had higher PE rates compared to NN group. Bilateral notch positivity increases both PE and early PE rates compared to notch negativity and unilateral notch positivity. The most sensitive and specific value of UA-PI for PE prediction was found 1,13. Conclusion: Uterine artery Doppler is a non-invasive and simple tool to identify high-risk pregnancies and may improve patient-specific practice. Especially pregnant women with a bilateral uterine notch accompanying with abnormal UA-PI values resulted a higher prevalence to develop these severe adverse outcomes. Closer monitoring may help to reduce both maternal and fetal morbidity and mortality in high-risk groups.

Anahtar Kelimeler

• diastolic notch
• uterine artery doppler
• preeclampsia
• pulsatility index

Kaynakça

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