PERİNATAL SONUÇLARI BELİRLEMEDE MSAFP VE ASAFP’NİN YERİ

Yıl 2020, Cilt: 17 Sayı: 4, 504 - 510, 31.12.2020

Elif Terzi , Serdar Ceylaner

https://doi.org/10.38136/jgon.735450

Öz

Amaç: Çalışmamızın amacı maternal serum alfa fetoprotein ve amniyotik sıvı alfa fetoprotein seviyelerinin olumsuz gebelik sonuçları üzerine etkisini değerlendirmektir. Yöntem: Bu çalışmada Zekai Tahir Burak Kadın Hastalıkları Eğitim ve Araştırma Hastanesine müracaat eden, üçlü tarama testi ve sonrasında amniyosentez yapılmış 88 hasta değerlendirildi. Gebelik sonuçları, maternal serum alfa fetoprotein ve amniyotik sıvı alfa fetoprotein sonuçları birlikte analiz edildi. Bulgular: Maternal serum alfa fetoprotein ve amniyotik sıvı alfa fetoprotein düzeyleri arasında korelasyon izlenmedi. Maternal serum alfa fetoprotein düzeyi ile oligohidramnios arasında istatistiksel olarak anlamlı bir ilişki bulunmasına rağmen preeklampsi, preterm eylem, ablasyo plasenta riski açısından anlamlı bir ilişki izlenmemiştir. Amniyotik sıvı alfa fetoprotein düzeyi ile olumsuz gebelik sonuçları arasında istatistiksel anlamlı bir ilişki gözlenmemiştir. Sonuç: Üçlü tarama testi içinde yer alan maternal serum alfa fetoprotein yüksekliği nöral tüp defekti için bir belirteç olmanın haricinde oligohidramnios öngörüsü için de önemli bir anlam içerir. Diğer olumsuz gebelik sonuçları ile ilişkisi tespit edilmemiştir.

Anahtar Kelimeler

MSAFP, ASAFP, olumsuz gebelik sonuçları

Kaynakça

• Referans 1. Aktaş FN. İkinci trimester maternal serum human koryonik gonadotropinin tek başına veya alfa fetoprotein ile birlikte artmış olduğu gebelerde obstetrik sonuçlar (Uzmanlık Tezi), Ahmet Gülkılık, Yayımlanmamış tez, İstanbul,2009
• Referans 2. Ozgunen FT. Nöral Tüp Defektleri ve Down Sendromunun Biyokimyasal Testlerle Taranması.T Klin J Gynecol Obst. 2002;12(4):348-354 , Referans 3. Hsu JJ, Hseih TT, Chiu TH, Liou JD, Soong YK. Alpha-Fetoprotein levels of paired samples between the amniotic fluid and maternal serum from 16 to 18 weeks' gestation in Chinese women.J Formos Med Assoc. 1994;93(5):374-378.
• Referans 4. Brock DJ, Sutcliffe RG. Alpha-fetoprotein in the antenatal diagnosis of anencephaly and spina bifida. Lancet. 1972;2(7770):197-199
• Referans 5. Wang ZP, Li H, Hao LZ, Zhao ZT. The effectiveness of prenatal serum biomarker screening for neural tube defects in second trimester pregnant women: a meta-analysis. Prenat Diagn. 2009;29(10):960-965.
• Referans 6. Chen Y, Zhang W. Maternal serum alpha fetoprotein and free β-hCG of second trimester for screening of fetal gastroschisis and omphalocele. Journal of Zhejiang University (Medical Science). 2017; 46(3): 268-273.
• Referans 7. Roman AS, Gupta S, Fox NS, Saltzman D, Klauser CK, Rebarber A. Is MSAFP still a useful test for detecting open neural tube defects and ventral wall defects in the era of first-trimester and early second-trimester fetal anatomical ultrasounds. Fetal Diagn Ther. 2015;37(3):206-210.
• Referans 8. Merkatz IR, Nitowsky HM, Macri JN, Johnson WE. An association between low maternal serum α-fetoprotein and fetal chromosomal abnormalities . Am J Obstet Gynecol. 1984;148(7):886-894.
• Referans 9. Wald NJ, Cuckle HS. Open neural tube defects. In: Wald NJ ed. Antenatal and neonatal screening. Oxford: Oxford Universty press 1984:24-73
• Referans 10. Mariona FG, Hassan MM, Syner FN, Chik LC, Sokol RJ.Maternal serum alpha-fetoprotein (MSAFP) and fetal growth.J Perinat Med. 1984;12(4):179-183.
• Referans 11. Öztürk H, Erkaya S, Altınbaş S, Karadağ B, Vanlı Tonyalı N, Özkan D. The role of unexplained high serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) levels in the second trimester to determine poor obstetric outcomes.Türk J Obstet Jinekoli. 2014 ; 11 (3): 142-147.
• Referans 12. Mor A, Tal R, Haberman S, McCalla S, Irani M, Perlman J, et al. Alpha-fetoprotein as a tool to distinguish amniotic fluid from urine, vaginal discharge, and semen. Obstet Gynecol. 2015;125(2):448-452.
• Referans 13. Delisle MF, Brosseuk L, Wilson RD. Amniocentesis for twin pregnancies: is alpha-fetoprotein useful in confirming that the two sacs were sampled. Fetal Diagn Ther. 2007;22(3):221-225.
• Referans 14. Yuan W, Chen L, Bernal AL. Is elevated maternal serum alpha-fetoprotein in the second trimester of pregnancy associated with increased preterm birth risk? A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2009 ;145 (1):57-64.
• Referans 15. Dehghani-Firouzabadi R, Tayebi N, Ghasemi N, Tahmasbi Z. The association between second-trimester maternal serum alpha-fetoprotein in 14-22 weeks and adverse pregnancy outcome. Acta Med Iran. 2010 ; 48 (4):234-238.
• Referans 16. Puntachai P, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K, Luewan S, et al. Associations between pregnancy outcomes and unexplained high and low maternal serum alpha-fetoprotein levels. Arch Gynecol Obstet. 2015 ;292 (1):81-85.
• Referans 17. Başbuğ D, Başbuğ A, Gülerman C. Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome. Ginekol Pol. 2017;88(6):325-330.
• Referans 18. Davidson EJ, Riley SC, Roberts SA, Shearing CH, Groome NP, Martin CW. Maternal serum activin, inhibin, human chorionic gonadotrophin and alpha-fetoprotein as second trimester predictors of pre-eclampsia. BJOG. 2003 ;110(1):46-52.
• Referans 19. Wald NJ, Morris JK. Multiple marker second trimester serum screening for pre-eclampsia. J Med Screen. 2001;8(2):65-68.
• Referans 20. Verspyck E, Degré S, Hellot MF, Descargues G, Philippe C, Labadie G, et al. Amniotic fluid alpha-fetoprotein is not a useful biological marker of pregnancy outcome. Prenat Diagn. 1999;19(11):1031-1034.
• Referans 21. Wenstrom KD, Owen J, Davis RO, Brumfield CG. Prognostic significance of unexplained elevated amniotic fluid alpha-fetoprotein. Obstet Gynecol. 1996 ;87(2):213-216.
• Referans 22. Morssink LP, Wolf BT, de, Kornman LH, Mantingh A. The relation between serum markers in the second trimester and placental pathology. Br J Obstet Gynaecol. 1996;103:779–783.
• Referans 23. Heinonen S, Ryynänen M, Kirkinen P, Saarikoski S. Uterine malformation: a cause of elevated maternal serum alpha-fetoprotein concentrations. Prenat Diagn. 1996; 16(7):635-639.
• Referans 24. Spong CY, Ghidini A, Walker CN, Ossandon M, Pezzullo JC. Elevated maternal serum midtrimester alpha-fetoprotein levels are associated with fetoplacental ischemia. Am J Obstet Gynecol. 1997 ;177(5):1085-1087.
• Referans 25. Salim R, Okopnik M, Garmi G, Nachum Z, Zafran N, Shalev E. Lack of association between unexplained elevated maternal serum alpha fetoprotein and/or human chorionic gonadotropin and the occurrence of placental thrombotic lesions. Placenta. 2010; 31(4):277-281.
• Referans 26. Hu J, Zhang J, Chan Y, Zhu B. A rat model of placental inflammation explains the unexplained elevated maternal serum alpha-fetoprotein associated with adverse pregnancy outcomes. J Obstet Gynaecol Res. 2019 ; 45(10):1980-1988.
• Referans 27. Sharony R, Dayan D, Kidron D, Manor M, Berkovitz A, Biron-Shental T, et al. Is the ratio of maternal serum to amniotic fluid AFP superior to serum levels as a predictor of pregnancy complications. Arch Gynecol Obstet. 2016 ;293 (4):767-770.
• Referans 28. Androutsopoulos G, Gkogkos P, Papadopoulos V, Adonakis G, Tsapanos V, Vassilakos P, et al. Mid-trimester maternal serum markers in predicting adverse pregnancy outcome. Clin Exp Obstet Gynecol. 2009;36(4):237-240.
• Referans 29. Androutsopoulos G, Gkogkos P, Decavalas G. Mid-trimester maternal serum HCG and alpha fetal protein levels: clinical significance and prediction of adverse pregnancy outcome. Int J Endocrinol Metab. 2013;11(2):102-106.
• Referans 30. Tancrède S, Bujold E, Giguère Y, Renald MH, Girouard J, Forest JC. Mid-trimester maternal serum AFP and hCG as markers of preterm and term adverse pregnancy outcomes. J Obstet Gynaecol Can. 2015;37(2):111-116.