Servikal Yetmezliği Olan Gebelerde Medikal Tedavi Yeterli mi? Acil Serklaj Uygulanmalı mı?

Öz

İkinci trimester gebelik kayıplarının %16-20’sinden servikal yetmezlik sorumludur. Bu çalışmanın amacı gebeliğin ikinci trimesterinde servikal yetmezlik tanısı ile acil serklaj ve medikal tedavi uyguladığımız hastalar ile yalnızca medikal tedavi yapılan kadınların maternal, perinatal sonuçlarını karşılaştırmaktır. Bu retrospektif çalışma, önceden erken doğum hikayesi olan, gebeliği tekiz ve 16-24. hafta arasında, servikal yetmezlik tanılı, amniotik membranı vajene prolabe olmuş hastalar değerlendirilerek yapıldı. Yatak istirahati tüm hastalara önerildi, serklaj tekniği olarak McDonalds yöntemi kullanıldı. Servikal yetmezlik tanısı alan hastalara tıbbi tedavi olarak antibiyotik profilaksisi, progesteron ayrıca indometasin veya nifedipin uygulandı. Bu hastalardan 24. gebelik haftasını dolduranlara akciğer olgunlaşması için betametazon verildi. Toplam 29 hastadan 19 hastaya acil serklaj + medikal tedavi, 10 hastaya yalnızca medikal tedavi uygulandı. Acil serklaj uyguladığımız hastalardan 7’sinin, medikal tedavi uyguladığımız 2 hastanın gebeliği geç abortusla sonuçlandı. Acil serklaj + medikal tedavi uygulanan hastalarda tedavi sonrası ortalama doğuma kadar geçen süre 24.83±12.44 gün; sadece medikal tedavi uygulananlarda ise 20.13±6.94 gündü. Serklaj + medikal tedavi uyguladığımız hastalarda doğum için kazanılan süre istatistiksel olarak anlamlı derecede daha fazlaydı (p=0.037). Servikal yetmezlik tanısı alan ve 24. gebelik haftasından sonra doğum yapan acil serklaj + medikal tedavi uygulanan hastaların 4'ünde, medikal tedavi alanların 3'ünde perinatal ölüm oldu. Acil serklaj + medikal tedavi uygulanan 19 hastanın 8'inde, sadece medikal tedavi uygulanan 10 hastanın 5'inde canlı doğum meydana geldi. Çalışmamızda acil serklaj uygulamalarının gebelik süresini uzattığını belirledik. Fakat acil serklaj ile kazanılan sürenin perinatal sonuçlara olumlu istatistiksel katkısı saptanmadı.

Anahtar Kelimeler

• Acil Servikal Serklaj
• Perinatal Sonuçlar
• Servikal Yetmezlik

Öz

Cervical insufficiency is responsible for 16-20% of second trimester losses. This study aims to compare the maternal and perinatal outcomes of the patients diagnosed with cervical insufficiency in the second trimester of pregnancy who underwent emergency cerclage and medical treatment with the patients, who were managed with only medical treatment. This retrospective study was conducted by evaluating the patients with a singleton pregnancy between the 16-24th weeks of gestation with a previous history of preterm labor, and diagnosis of cervical insufficiency, and prolapsed amniotic membrane in to the vagina. The cerclage was applied using the McDonald technique. Antibiotic prophylaxis, progesterone, indomethacin, or nifedipine were administered as medical treatment to the patients diagnosed with cervical insufficiency. It was found that among these patients, beta methasone was administered for lung maturation in those who completed the 24th gestational week. Out of a total of 29 patients, 19 patients received emergency cerclage and medical treatment, and 10 patients received only medical treatment. 7 of the patients who underwent emergency cerclage, and 2 patients that we applied medical treatment, resulted in late abortion. The mean delivery time after treatment was 24.83±12.44 days in patients who applied emergency cerclage + medical treatment; and was 20.13±6.94 days in patients who only applied medical treatment. The extra time for delivery was statistically significantly higher in the patients we applied cerclage + medical treatment (p=0.037). Perinatal death occurred in 4 of the patients diagnosed with cervical insufficiency who received emergency cerclage + medical treatment and 3 of the patients who received medical treatment after their 24th gestational week. Live births occurred in 8 of 19 patients in whom emergency cerclage + medical treatment was applied, and in 5 of 10 patients who have applied only medical treatment. In our study, we determined that emergency cerclage applications prolong the gestational period. However, no positive statistically significant contribution was found in the time gained by emergency cerclage on perinatal outcomes.

Anahtar Kelimeler

• Emergency Cervical Cerclage
• Perinatal Outcomes
• Cervical Insufficiency

Kaynakça

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