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KLİNİĞİMİZDE UYGULANAN FETOSİD VAKALARININ RETROSPEKTİF DEĞERLENDİRİLMESİ

Yıl 2017, Cilt: 8 Sayı: 29, 27 - 33, 01.03.2017

Oya Soylu Karapınar

https://doi.org/10.17944/mkutfd.304247

Öz

Amaç: Kliniğimizde canlı ektopik gebelik,
üçüzden ikize redüksiyon, ikiz eşinde major anomali olan vakalarda uygulanan
selektif fetosid işleminin perinatal sonuçlarını ve ektopik gebeliklerin
sonuçları ile ilgili retrospektif verileri sunmayı amaçladık



Gereç ve Yöntem: Fetosid işlemi
için ultrason eşliğinde 2-3 ml potasyum klorid (KCl) intrakardiak
uygulanmıştır.



Bulgular: Üçüz olguda redüksiyon işlemi 13-14
hafta arası uygulandı ve 36. haftada sağlıklı ikiz bebekler doğurtuldu. İkiz
eşinde ensefalosel ve anensefali olan gebeliklerde sırasıyla 16.  ve 14. haftalarda selektif fetosid uygulandı.
Ensefaloselli ikiz gebelikte 1 gün sonra normal olan fetus ex oldu ve 2 gün
sonra gebelik düşükle sonuçlandı. Anensefalili ikiz gebelikte ise selektif
fetosid uygulanan fetusta aynı gün erken membran rüptürü oldu ve 1 hafta
sonraki kontrolde biri ex diğeri canlı 15 haftalık, amniyon mayi normal gebelik
izlendi. Patau sendromlu olan ikiz eşine 17. haftada selektif fetosid uygulandı
ve bu olgu 38. gebelik haftasında doğurtuldu. Ektopik gebelik tanısı alan 3
olgu 6-7. gebelik haftalarında, fetal kalp atımı pozitif olup human koryonik
gonadotropin (beta –HCG) değerleri yüksek idi (10.000 IU, 27.000 IU ve 50.000
IU idi). Bu olgularda ise beta-HCG değerleri 3-4 hafta içinde sıfırlandı ve
operasyona gerek kalmadı.



Sonuç: Dikoryonik diamniotik ikiz eşi majör
fetal anomalili gebeliklerde selektif fetosid, trikoryonik triamniyotik üçüz
eşine sağlıklı fetüsün yaşam şansını arttırmaya ve morbiditeyi azaltmaya
yönelik reduksiyon işlemi ultrasonografi eşliğinde intrakardiak KCL
uygulanabilen bir yöntemdir ve muhtemel komplikasyonları tartışılarak ailelere
prenatal tedavi seçeneği olarak sunulmalıdır. Rüptüre olmayan canlı ektopik gebeliğin
birçok tipi lokal KCL ile cerrahi müdahale olmadan başarılı bir şekilde tedavi
edilebilir.

Anahtar Kelimeler

Dikoryonik diamniyotik ikizlik selektif fetosid potasyum klorid metotreksat

Kaynakça

  • 1. Blondel B, Kaminski M. Trends in the occurence, determinants and consequences of multiple births. Semin Perinatol 2002;26:239-49
  • 2. Wimalasundera R.C. Selective reduction and termination of multiple pregnancies. Seminars in fetal &neonatal medicine 2010;15:327-35
  • 3. Mastroiacovo P, Castilla EE, Arpino C. Congenital malformations in twins: an international study. Am J Med Genet 1999;83:117-24
  • 4. Rustico M.A, Baietti M.G, Coviello D, Orlondi E, Nicolini U. Managing twins discordant for fetal anomaly. Prenatal diagn 2005;25:766-71
  • 5. Evans MI, Goldberg JD, Dommergues M, Wapner RJ, Lynch L, Dock BS et al. Efficacy of second trimester selective termination for fetal abnormalities: international collaborative experience among the world’s largest centers. Am J Obstet Gynecol 1994;171:90-4
  • 6. Bergh T, Ericson A, Hillensjo T, Nygren KG, Wennerholm UB. Deliveries and children born after in-vitro fertilization in Sweden 1982-95: a retrospective cohort study. Lancet 1999;354(9190):1579-85
  • 7. Legendre C.M, Moutel G, Drouin R, Favre R, Bouffard C. Differences between selective termination of pregnancy and fetal reduction in multiple pregnancy:a narrative review. Reproductive Biomedicine Online 2013;26:542-54
  • 8. Cheang CU, Huang LS, Lee TH, Liu CH, Shih YT, Lee MS. A comparison of the outcomes between twin and reduced twin pregnancies produced through assisted reproduction. Fertil Steril 2007;88:47-52
  • 9. Lipitz S, Uval J, Achiron R, Schiff E, Lusky A, Reichman B. Outcome of twin pregnancies reduced from triplets compared with nonreduced twin gestations. Obstet Gynecol 1996;87:511-4
  • 10. Evans MI, Berkowitz RL, Wapner RJ. İmprovement in outcomes with of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol 2001;184:97-103
  • 11. Stone J, Ferrara L, Kamrath J. Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction. Am J Obstet Gynecol 2008;199:406.e1-4
  • 12. Melgar CA, Rosenfeld DI, Rawlinson K, Greenberg M. Perinatal outcome after multifetal reduction to twins compared with nonreduced multiple gestations. Obstet Gynecol 1991;78(5 pt 1):763-7
  • 13. Landy HJ, Keith LG. The vanishing twin: a review. Hum Reprod Update 1998;4:177-83.
  • 14. Lipitz S, Shulman A, Achiron R, Zalel Y, Seidman DS. A comparative study of multifetal pregnancy reduction from triplets to twins in the first versus early second trimesters after detailed fetal screening. Ultrasound Obstet Gynecol 2001;18:35-8.
  • 15. Evans MI, Britt DW. Fetal reduction. Semin Perinatol 2005;29:321-9.
  • 16. Devine PC, Malone FD, Athanassiou A, Harvey-Wilkes K, D’Alton ME. Maternal and neonatal outcome of 100 consecutive triplet pregnancies. Am J Perinatol 2001;18:225-35.
  • 17. Petterson B, Nelson KB, Watson L, Stanley F. Twins, triplets, and cerebral palsy in births in Western Australia in the 1980s. BMJ 1993;307(6914):1239-43.
  • 18. ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod 2000;15:1856-64.
  • 19. Papageorghiou AT, Avgidou K, Bakoulas V, Sebire NJ, Nicolaides KH. Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review. Hum Reprod 2006;21:1912-7.
  • 20. Evans MI, Goldberg JD, Horenstein J, Wapner RJ, Ayoub MA, Stone J et al. Selective termination for structural, chromosomal, and Mendelian anomalies: international experience. Am J Obstet Gynecol 1999;181:893-7.
  • 21. Heydanus R, Santema JG, Stewart PA, Mulder PG, Wladimiroff JW. Pretem delivery rate and fetal outcome in structurally affected twin pregnancies: a retrospective matched control study. Prenat Diagn 1993;13:155-162
  • 22. Monteagudo A, Minior VK, Stehenson C, Monda S, Timor-Tritsch E .Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series. Ultrasound Obstet Gynecol 2005;25:282-8
  • 23. Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 1999; 341:1974-8
  • 24. Dadhwal V, Deka D, Ghosh B, Mittal S. Successful management of live ectopic pregnancy with high B-HCG titres by ultrasound-guided potassium chloride injection and systemic methotrexate. Arch Gynecol Obstet 2009; 280: 799-801
  • 25. Aboulghar MA, Mansour RT, Serour GI. Transvaginal injection of potassium chloride and methotrexate fort he treatment for tubal pregnancy with a live fetus. Human Reprod 1990; 5:887
  • 26. Doubilet PM, Benson CB, Frates MC. Sonographically guided minimally invasive treatment of unusual ectopic pregnancies. J Ultrasound Med 2004;23:359

Yıl 2017, Cilt: 8 Sayı: 29, 27 - 33, 01.03.2017

Oya Soylu Karapınar

https://doi.org/10.17944/mkutfd.304247

Öz

Kaynakça

  • 1. Blondel B, Kaminski M. Trends in the occurence, determinants and consequences of multiple births. Semin Perinatol 2002;26:239-49
  • 2. Wimalasundera R.C. Selective reduction and termination of multiple pregnancies. Seminars in fetal &neonatal medicine 2010;15:327-35
  • 3. Mastroiacovo P, Castilla EE, Arpino C. Congenital malformations in twins: an international study. Am J Med Genet 1999;83:117-24
  • 4. Rustico M.A, Baietti M.G, Coviello D, Orlondi E, Nicolini U. Managing twins discordant for fetal anomaly. Prenatal diagn 2005;25:766-71
  • 5. Evans MI, Goldberg JD, Dommergues M, Wapner RJ, Lynch L, Dock BS et al. Efficacy of second trimester selective termination for fetal abnormalities: international collaborative experience among the world’s largest centers. Am J Obstet Gynecol 1994;171:90-4
  • 6. Bergh T, Ericson A, Hillensjo T, Nygren KG, Wennerholm UB. Deliveries and children born after in-vitro fertilization in Sweden 1982-95: a retrospective cohort study. Lancet 1999;354(9190):1579-85
  • 7. Legendre C.M, Moutel G, Drouin R, Favre R, Bouffard C. Differences between selective termination of pregnancy and fetal reduction in multiple pregnancy:a narrative review. Reproductive Biomedicine Online 2013;26:542-54
  • 8. Cheang CU, Huang LS, Lee TH, Liu CH, Shih YT, Lee MS. A comparison of the outcomes between twin and reduced twin pregnancies produced through assisted reproduction. Fertil Steril 2007;88:47-52
  • 9. Lipitz S, Uval J, Achiron R, Schiff E, Lusky A, Reichman B. Outcome of twin pregnancies reduced from triplets compared with nonreduced twin gestations. Obstet Gynecol 1996;87:511-4
  • 10. Evans MI, Berkowitz RL, Wapner RJ. İmprovement in outcomes with of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol 2001;184:97-103
  • 11. Stone J, Ferrara L, Kamrath J. Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction. Am J Obstet Gynecol 2008;199:406.e1-4
  • 12. Melgar CA, Rosenfeld DI, Rawlinson K, Greenberg M. Perinatal outcome after multifetal reduction to twins compared with nonreduced multiple gestations. Obstet Gynecol 1991;78(5 pt 1):763-7
  • 13. Landy HJ, Keith LG. The vanishing twin: a review. Hum Reprod Update 1998;4:177-83.
  • 14. Lipitz S, Shulman A, Achiron R, Zalel Y, Seidman DS. A comparative study of multifetal pregnancy reduction from triplets to twins in the first versus early second trimesters after detailed fetal screening. Ultrasound Obstet Gynecol 2001;18:35-8.
  • 15. Evans MI, Britt DW. Fetal reduction. Semin Perinatol 2005;29:321-9.
  • 16. Devine PC, Malone FD, Athanassiou A, Harvey-Wilkes K, D’Alton ME. Maternal and neonatal outcome of 100 consecutive triplet pregnancies. Am J Perinatol 2001;18:225-35.
  • 17. Petterson B, Nelson KB, Watson L, Stanley F. Twins, triplets, and cerebral palsy in births in Western Australia in the 1980s. BMJ 1993;307(6914):1239-43.
  • 18. ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod 2000;15:1856-64.
  • 19. Papageorghiou AT, Avgidou K, Bakoulas V, Sebire NJ, Nicolaides KH. Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review. Hum Reprod 2006;21:1912-7.
  • 20. Evans MI, Goldberg JD, Horenstein J, Wapner RJ, Ayoub MA, Stone J et al. Selective termination for structural, chromosomal, and Mendelian anomalies: international experience. Am J Obstet Gynecol 1999;181:893-7.
  • 21. Heydanus R, Santema JG, Stewart PA, Mulder PG, Wladimiroff JW. Pretem delivery rate and fetal outcome in structurally affected twin pregnancies: a retrospective matched control study. Prenat Diagn 1993;13:155-162
  • 22. Monteagudo A, Minior VK, Stehenson C, Monda S, Timor-Tritsch E .Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series. Ultrasound Obstet Gynecol 2005;25:282-8
  • 23. Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 1999; 341:1974-8
  • 24. Dadhwal V, Deka D, Ghosh B, Mittal S. Successful management of live ectopic pregnancy with high B-HCG titres by ultrasound-guided potassium chloride injection and systemic methotrexate. Arch Gynecol Obstet 2009; 280: 799-801
  • 25. Aboulghar MA, Mansour RT, Serour GI. Transvaginal injection of potassium chloride and methotrexate fort he treatment for tubal pregnancy with a live fetus. Human Reprod 1990; 5:887
  • 26. Doubilet PM, Benson CB, Frates MC. Sonographically guided minimally invasive treatment of unusual ectopic pregnancies. J Ultrasound Med 2004;23:359
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Original Articles
Yazarlar

Oya Soylu Karapınar

Yayımlanma Tarihi 1 Mart 2017
Gönderilme Tarihi 1 Temmuz 2016
Kabul Tarihi 1 Mart 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 8 Sayı: 29

Kaynak Göster

Vancouver Soylu Karapınar O. KLİNİĞİMİZDE UYGULANAN FETOSİD VAKALARININ RETROSPEKTİF DEĞERLENDİRİLMESİ. mkutfd. 2017;8(29):27-33.