Erken Gebelikte Vajinal Kanamanın İlk Trimester Tarama Testi, Uterin Arter Doppler İndeksleri ve Perinatal Sonuçlara Etkisi

Yıl 2023, Cilt: 5 Sayı: 2, 393 - 9, 15.05.2023

Meriç Balıkoğlu Burak Bayraktar Azra Arıcı Yurtkul Mehmet Özeren

https://doi.org/10.37990/medr.1196046

Öz

Amaç: Bu çalışmada birinci trimesterde görülen vajinal kanamanın birinci trimester tarama testi, uterin arter (UtA) Doppler sonuçları ve perinatal sonuçlara etkisini prospektif olarak araştırmayı amaçladık.
Gereç ve Yöntem: 2019-2020 yılları arasında ilk trimesterde vajinal kanama ile başvuran elli olgu erken gebelik kanaması (abortus imminens-düşük tehditi) grubunu, gebelikte vajinal kanama öyküsü olmayan elli olgu ise kontrol grubunu oluşturdu. Demografik veriler ilk ziyarette not edildi. Her iki grup doğuma kadar takip edildi. 11-14. haftalar arasında birinci trimester tarama testi (ikili tarama testi) ve 20-24. gebelik haftaları arasında UtA Doppler incelemesi yapıldı. Ense saydamlığı (NT), serbest beta-insan koryonik gonadotropini (f β-hCG), gebelikle ilişkili plazma protein-A (PAPP-A) ve UtA Doppler'in değerleri ve perinatal sonuçlar iki grup arasında karşılaştırıldı.
Bulgular: Birinci trimester tarama testinde bakılan NT ve PAPP-A açısından iki grup arasında istatistiksel olarak anlamlı fark bulunmadı (sırasıyla p=0.741 ve p=0.937). Abortus imminens grubunda f β-hCG değeri sayısal olarak belirgin yüksekti ancak sonuçlar istatistiksel olarak anlamlı anlamlı değildi (1.24±0.59 vs. 1.1±0.93, p=0.057). Uterin arterin Doppler incelemesinde sistol/diyastol oranı, pulsatilite indeksi, direnç indeksi ve çentik varlığı açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu. (sırasıyla p=0.713, p=0.528, p=424, p=0.538). Perinatal komplikasyon oranı çalışma grubunda anlamlı olarak yüksekti (p = 0.013; Odds Ratio: 3.2, %95 GA 1.2 - 8.3).
Sonuç: Literatürde ki bazı farklı çalışmaların aksine birinci trimester tarama testi parametrelerinin veya uterin arter Doppler akım indekslerinin ilk trimesterde vajinal kanama öyküsü olan gebelerin perinatal sonuçlarını öngörmede yeri olmadığını düşünüyoruz. Ayrıca erken gebelik kanaması, tarama parametrelerini önemli ölçüde etkilememektedir. Abortus imminens grubunda perinatal komplikasyon oranı istatistiksel olarak anlamlı derecede yüksetir.

Anahtar Kelimeler

Doppler, uterin arter, abortus imminens, düşük tehditi, vajinal kanama, ilk trimester

Destekleyen Kurum

Yoktur

Proje Numarası

Yoktur

The Effect of Vaginal Bleeding in Early Pregnancy on First Trimester Screening Test, Uterine Artery Doppler Indices and Perinatal Outcomes

Öz

Aim: We aimed to prospectively investigate the effect of first trimester vaginal bleeding on first trimester screening test, uterine artery (UtA) Doppler results and perinatal outcomes.
Material and Methods: Fifty cases that presented with vaginal bleeding in the first trimester between 2019 and 2020 constituted the early vaginal bleeding (abortus imminens-threatened abortion) group and fifty cases without a history of vaginal bleeding in pregnancy constituted the control group. Demographic datas were noted at the first visit. Both groups were followed up until birth. First trimester screening test (double screening test) between 11-14 weeks and UtA Doppler examination between 20-24 weeks of gestation was performed. Perinatal outcomes and values of nuchal translucency (NT), free β human chorionic gonadotropin (f β-hCG), pregnancy-associated plasma protein A (PAPP-A), and UtA Doppler were compared between the two groups.
Results: There was no statistically significant difference was found between the two groups in terms of NT and PAPP-A among the first trimester screening test results (p=0.741 and p=0.937, respectively). In the group with threatened miscarriage, f β-hCG value was numerically higher, but there was no statistically significant difference (1.24±0.59 vs. 1.1±0.93, p=0.057). In the Doppler examination of the UtA, there was no statistically significant difference between the groups in terms of systolic/diastolic ratio, pulsatility index, resistive index and the presence of a notch (p=0.713, p=0.528, p=424, p=0.538, respectively). Perinatal complication rate was statistically significantly higher in the study group (p=0.013; Odds Ratio:3.2, 95% CI 1.2-8.3).
Conclusion: Contrary to some different studies, we believe that first trimester screening test parameters or uterine artery Doppler flow indices do not have a place in predicting perinatal outcomes of pregnant women with a history of vaginal bleeding in the first trimester. In addition, early vaginal bleeding does not significantly affect screening parameters. Perinatal complication rate was found to be statistically significantly higher in the group with a history of threatened miscarriage.

Anahtar Kelimeler

Doppler, uterine artery, abortus imminens, threatened abortion, vaginal bleeding, first trimester

Proje Numarası

Yoktur

Kaynakça

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