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PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ

Yıl 2015, Cilt: 2 Sayı: 2, 13 - 25, 29.11.2015

Öz

Amaç: Preterm Erken Membran Rüptürü(PEMR) olgularında maternal ve neonatal sonuçların araştırılmasını amaçladık.

Gereç ve yöntemler: PEMR tanısı alan 145 tekiz gebelik geriye dönük incelendi. Maternal ve fetal etkileri incelenmesinde gebelik haftasına göre üç gruba ayrıldı. I. Grup: 29 gebelik haftası ve altı, 13 hasta. II. Grup: 30-34 gebelik haftası, 46 hasta. III. Grup: 34 gebelik haftası ve üzeri, 86 hasta olarak belirlendi. Grupların maternal ve neonatal sonuçları analiz edildi.

Bulgular: Çalışmaya katılan olguların yaş ortalaması 28,20±5,53 yıl olarak bulundu. Gestasyonel hafta ayrımına göre, olguların yaş, gravida, parite dağılımı, eğitim durumu, USG’ de AFI dağılımı, idrar kültürü dağılımı, tokoliz durumu, latent süre dağılımı arasında anlamlı fark bulunamamıştır(p>0.05). Gestasyonel hafta ayrımına göre olguların CRP, WBC ve ateş durumu dağılımında istatistiksel olarak anlamlı farklılık tespit edildi(p<0.05). Gestasyonel hafta ayrımına göre olguların doğum şekli dağılımında da anlamlı farklılık vardı(p<0,05).

Sonuç: Çalışmamızda morbidite ve mortalite oranını gebelik yaşına göre irdelediğimizde yenidoğan açısından en önemli morbidite nedeni olan RDS’ un 29. gebelik haftası ile başlayarak giderek azaldığı, her hafta için yaklaşık %10-15 lik azalma saptandığı belirlenmiştir. 29. gebelik haftası ile birlikte PEMR olgularında neonatal mortalite %50’ nin altına inerken, 32. gebelik haftası ile %10’ un altına inmektedir. PEMR olgularının 29. gebelik haftası ile birlikte ”bekle ve gör” yaklaşımı ile izlenmesinin neonatal morbidite ve mortalite açısından çok faydalı sonuçlar sağlayacağı kanaatindeyiz. 29. gebelik haftası altındaki olgularda neonatal prognoz ‘‘bekle ve gör” yaklaşımını desteklemeyecek kadar düşüktür.

 

Anahtar kelimeler: Preterm Erken Membran Rüptürü, Respiratuar Distres Sendromu

 

 

                                                                                                          

 

ABSTRACT

 

Objective: We aimed to investigate the cases of maternal and neonatal outcomes of Preterm premature rupture of membranes(PEMR).

Material and Methods: PEMR diagnosis of 145 singleton pregnancies were surveyed retrospectively. The examining of maternal and fetal effects were divided into three groups according to the study weeks of pregnancy. Group I: 29 weeks of pregnancy or less, 13 patients. Group II : 30-34 weeks of pregnancy, 46 patients. Group III : 34 weeks of pregnancy and more, were identified as 86 patients. Maternal and neonatal results of the two groups were analyzed.

Results: The average of the patients that are participated into this study has found 28,20±5,53. According to gestational week discrimination, the case of age, gravida, parity distribution, education level, USG of AFI distribution, urine culture distribution, tocolysis situation, latency time distribution have no significant difference with each other (p>0.05). According to gestational week discrimination was a significant difference in the distribution mode of delivery of the patients (p <0.05).

Conclusion: In our study when we examine gestational age of morbidity and mortality rate of the most important causes of morbidity in terms of the new born RDS’s 29th week of pregnancy as beginning with diminishing, It was determined that there was approximate reduction about %10-%15 per week. During the 29th week of pregnancy, neonatal mortality of Pemr event reduced more than %50 percetange, during the 32th week of gestation with %10 of it is below. With 29 weeks of pregnancy "wait and see" approach to monitoring and neonatal morbidity and we believe will provide very useful results in terms of mortality. Underlying 29th weeks pregnancy events neonatal prognosis wait and see approach is too low to support.

Keywords: Preterm labor, early membrane rupture, respiratory distress syndrome 

Kaynakça

  • Söylemez F. Erken membran rupturü. In: Kişnişçi H.A, Gökşin E, Durukan T, Üstay K, Ayhan A, Gürgan T, Önderoğlu L.S (Editörler). Temel Kadın Hastalıkları ve Doğum Bilgisi. Ankara: Güneş Kitabevi, 1996:1465–1480.
  • Scott JR, Disaina J, Hammond CB, Spellacy WN. Danforth’s Obstetrics and Gynecology. Seventy Edition 1994: 305–316.
  • Roberts WE, Morrison JC, Cheryl H, Wiser WL. The incidence of preterm labor and specific risk factors. Obstet. Gynecol. 1990; 76:85–89.
  • Mercer BM, Goldenberg RL, Moaward AH, Shellhaas C, Das A, Menard M.K, et al. The preterm prediction study: prediction of preterm premature rupture of membranes through clinical findings and ancillary testing. Am J ObstetGynecol 2000; 183:738–745.
  • Gabbe SG, Neebly JR, Simphson JL Obstetrics. Normal and problem pregnancies. Third Edition 1996: 743–820.
  • Oshiara BT. İntra-amniotic infections; Seminars in perinatology 1993; 17(6):20-25
  • Lockwood CJ, Costigan K, Ghidini A et al. Double –blind, placebo-controlled trial of piperacillin prophylaxis in preterm membrane rupture. Am J Obstet. Gynecol 1993; 169:970-976.
  • Mercer B, Miodovnik M, Thurnau G, et al. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes: A randomized controlled trial. JAMA 1997; 278:989-995.
  • Lewis DF, Fontenot MT, Brooks GG, Wise R, Perkins MB, Heymann AR. Latency period after preterm premature rupture of membranes: A comparison of ampicillin with and without sulbactam. Obstet. Gynecol 1995; 86:392-395.
  • Mercer BM, Goldenberg RL, Das A, Moawad AH Lams JD, Copper RL, Johnson F, Thom E, Mcnellis D, Miodovnik M, Menard MK, Caaritis SN, Thunau GR, Bottoms SF, Roberts J. The preterm prediction study: A clinical risk assessment system. Am J Obstet. Gynecol 1996; 174:1885–1895.
  • Owen J, Goldenberg RL, Davis RO, Kirk KA, Copper RL. Evaluation of a risk scoring system as a predictor of pretermbirth in an indigent population. Am J Obstet. Gynecol 1990; 163:873–879.
  • Pasquier JC, Rabilloud M. A prospective population-based study of 598 cases of PPROM between 24 and 34 weeks' gestation: description, management, andmortality. Eur J Obstet Gynecol Reprod Biol. 2005; 121(2):164-170.
  • Mercer BM. Managment of premature rupture of membranes before 26 weeks’gestation. Obstet Gynecol Clin North Am 1992; 19:339-351.
  • Morales WJ. The effect of choriyo amniyonitis on the developmental outcome of preterm infants at oneyear. Obset. Gynecol 1987; 70:183-186.
  • Alexander JM, Mercer BM, Miodıvnik M, Thurnau GR, et al. The impact of digital cervical examination on expectantly managed preterm rupture of membranes. Am J Obstet. Gynecol 2000; 183(4):1003-1007.
  • Saigel JD, Rosenbaum P, Hattersly B et al. Decreased disability rate among 3 year old survivors weighting 501-1000 gr. at birth and born to residants of a geographically defined region fron 1981 to 1984 compared 1977 to 1980. J Pediat 1989; 114:839-845.
  • Hansen T, Corbet A: Respiratory system. In: Avery’s diseases of the newborn. Taeusch HW, Ballard RA, (eds). W.B.SaundersCo.,Philadelphia. 1998, pp: 541-698.
  • Mercer BM. Preterm premature rupture of membranes. Obstet. Gynecol 2003; 101:178–193.
  • Vinzilleous AM, Winston WA, Nochimson DJ et al. Degree of oligohidramnios and pregnancy outcome in patients with premature rupture of membranes. ObstetGynecol 1985; 66:162-167
  • Ramsey PS, Lieman JM, Brumfield CG, Carlo W. Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes. Am J Obstet. Gynecol 2005; 192(4):1162-1166.
  • Vintzileus AM. Tests of fetal well-being in premature rupture of RF membranes; rationals and results. Clin North Am Obstet Gynecol 1992; 19(2):281-309.
  • Lewis DF, Adair CD, Robichaux AG et al. Antibiyotic thrapy in preterm premature rupture of membranes: are seven days necessary? A preliminary, randomized clinical trial. Am J ObsetGynecol 2003; 188:1413-1416.
  • Tanir HM, Sener T, Tekin N, Aksit A, Ardic N. Preterm premature rupture of membranes and neonatal outcome prior to 34 weeks of gestation. Int J GynaecolObstet. 2003; 82(2):167–72
  • Karabulut AA, Durukan T. Prematür membran rüptürü: maternal ve neonatal etkilerin incelenmesi. Perinatoloji dergisi 1999; 7(3):248-254
  • Kenyon SL, Taylor DJ, Tarnow-Mordi W. Broad spectrum antbiyotics for preterm rupture of membranes. Cochrane Database of Systematic Reviews 2003, Issue 2. Art No: CD001058. DOI: 10.1002/14651858.CD001058.
  • Obi SN, Ozumba BC. Pre-termpremature rupture of fetal membranes: the dilemma of management in a developing nation. J ObstetGynecol. 2007; 27(1):37–40.
Yıl 2015, Cilt: 2 Sayı: 2, 13 - 25, 29.11.2015

Öz

Kaynakça

  • Söylemez F. Erken membran rupturü. In: Kişnişçi H.A, Gökşin E, Durukan T, Üstay K, Ayhan A, Gürgan T, Önderoğlu L.S (Editörler). Temel Kadın Hastalıkları ve Doğum Bilgisi. Ankara: Güneş Kitabevi, 1996:1465–1480.
  • Scott JR, Disaina J, Hammond CB, Spellacy WN. Danforth’s Obstetrics and Gynecology. Seventy Edition 1994: 305–316.
  • Roberts WE, Morrison JC, Cheryl H, Wiser WL. The incidence of preterm labor and specific risk factors. Obstet. Gynecol. 1990; 76:85–89.
  • Mercer BM, Goldenberg RL, Moaward AH, Shellhaas C, Das A, Menard M.K, et al. The preterm prediction study: prediction of preterm premature rupture of membranes through clinical findings and ancillary testing. Am J ObstetGynecol 2000; 183:738–745.
  • Gabbe SG, Neebly JR, Simphson JL Obstetrics. Normal and problem pregnancies. Third Edition 1996: 743–820.
  • Oshiara BT. İntra-amniotic infections; Seminars in perinatology 1993; 17(6):20-25
  • Lockwood CJ, Costigan K, Ghidini A et al. Double –blind, placebo-controlled trial of piperacillin prophylaxis in preterm membrane rupture. Am J Obstet. Gynecol 1993; 169:970-976.
  • Mercer B, Miodovnik M, Thurnau G, et al. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes: A randomized controlled trial. JAMA 1997; 278:989-995.
  • Lewis DF, Fontenot MT, Brooks GG, Wise R, Perkins MB, Heymann AR. Latency period after preterm premature rupture of membranes: A comparison of ampicillin with and without sulbactam. Obstet. Gynecol 1995; 86:392-395.
  • Mercer BM, Goldenberg RL, Das A, Moawad AH Lams JD, Copper RL, Johnson F, Thom E, Mcnellis D, Miodovnik M, Menard MK, Caaritis SN, Thunau GR, Bottoms SF, Roberts J. The preterm prediction study: A clinical risk assessment system. Am J Obstet. Gynecol 1996; 174:1885–1895.
  • Owen J, Goldenberg RL, Davis RO, Kirk KA, Copper RL. Evaluation of a risk scoring system as a predictor of pretermbirth in an indigent population. Am J Obstet. Gynecol 1990; 163:873–879.
  • Pasquier JC, Rabilloud M. A prospective population-based study of 598 cases of PPROM between 24 and 34 weeks' gestation: description, management, andmortality. Eur J Obstet Gynecol Reprod Biol. 2005; 121(2):164-170.
  • Mercer BM. Managment of premature rupture of membranes before 26 weeks’gestation. Obstet Gynecol Clin North Am 1992; 19:339-351.
  • Morales WJ. The effect of choriyo amniyonitis on the developmental outcome of preterm infants at oneyear. Obset. Gynecol 1987; 70:183-186.
  • Alexander JM, Mercer BM, Miodıvnik M, Thurnau GR, et al. The impact of digital cervical examination on expectantly managed preterm rupture of membranes. Am J Obstet. Gynecol 2000; 183(4):1003-1007.
  • Saigel JD, Rosenbaum P, Hattersly B et al. Decreased disability rate among 3 year old survivors weighting 501-1000 gr. at birth and born to residants of a geographically defined region fron 1981 to 1984 compared 1977 to 1980. J Pediat 1989; 114:839-845.
  • Hansen T, Corbet A: Respiratory system. In: Avery’s diseases of the newborn. Taeusch HW, Ballard RA, (eds). W.B.SaundersCo.,Philadelphia. 1998, pp: 541-698.
  • Mercer BM. Preterm premature rupture of membranes. Obstet. Gynecol 2003; 101:178–193.
  • Vinzilleous AM, Winston WA, Nochimson DJ et al. Degree of oligohidramnios and pregnancy outcome in patients with premature rupture of membranes. ObstetGynecol 1985; 66:162-167
  • Ramsey PS, Lieman JM, Brumfield CG, Carlo W. Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes. Am J Obstet. Gynecol 2005; 192(4):1162-1166.
  • Vintzileus AM. Tests of fetal well-being in premature rupture of RF membranes; rationals and results. Clin North Am Obstet Gynecol 1992; 19(2):281-309.
  • Lewis DF, Adair CD, Robichaux AG et al. Antibiyotic thrapy in preterm premature rupture of membranes: are seven days necessary? A preliminary, randomized clinical trial. Am J ObsetGynecol 2003; 188:1413-1416.
  • Tanir HM, Sener T, Tekin N, Aksit A, Ardic N. Preterm premature rupture of membranes and neonatal outcome prior to 34 weeks of gestation. Int J GynaecolObstet. 2003; 82(2):167–72
  • Karabulut AA, Durukan T. Prematür membran rüptürü: maternal ve neonatal etkilerin incelenmesi. Perinatoloji dergisi 1999; 7(3):248-254
  • Kenyon SL, Taylor DJ, Tarnow-Mordi W. Broad spectrum antbiyotics for preterm rupture of membranes. Cochrane Database of Systematic Reviews 2003, Issue 2. Art No: CD001058. DOI: 10.1002/14651858.CD001058.
  • Obi SN, Ozumba BC. Pre-termpremature rupture of fetal membranes: the dilemma of management in a developing nation. J ObstetGynecol. 2007; 27(1):37–40.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil TR, EN
Bölüm Makaleler
Yazarlar

Abdül Güler

Yüksel Sayın Bu kişi benim

Yayımlanma Tarihi 29 Kasım 2015
Yayımlandığı Sayı Yıl 2015 Cilt: 2 Sayı: 2

Kaynak Göster

APA Güler, A., & Sayın, Y. (2015). PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Dergisi Medi ForuM, 2(2), 13-25.
AMA Güler A, Sayın Y. PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Dergisi Medi ForuM. Kasım 2015;2(2):13-25.
Chicago Güler, Abdül, ve Yüksel Sayın. “PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ”. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Dergisi Medi ForuM 2, sy. 2 (Kasım 2015): 13-25.
EndNote Güler A, Sayın Y (01 Kasım 2015) PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Dergisi Medi ForuM 2 2 13–25.
IEEE A. Güler ve Y. Sayın, “PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ”, Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Dergisi Medi ForuM, c. 2, sy. 2, ss. 13–25, 2015.
ISNAD Güler, Abdül - Sayın, Yüksel. “PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ”. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Dergisi Medi ForuM 2/2 (Kasım 2015), 13-25.
JAMA Güler A, Sayın Y. PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Dergisi Medi ForuM. 2015;2:13–25.
MLA Güler, Abdül ve Yüksel Sayın. “PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ”. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Dergisi Medi ForuM, c. 2, sy. 2, 2015, ss. 13-25.
Vancouver Güler A, Sayın Y. PRETERM ERKEN MEMBRAN RÜPTÜRÜ OLGULARINDA MATERNAL VE NEONATAL SONUÇLARIN DEĞERLENDİRİLMESİ. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Dergisi Medi ForuM. 2015;2(2):13-25.