Erken membran rüptürü olan 36-42 haftalýk gebelerde maternal ve fetal sonuçlar

Year 2008, Volume: 15 Issue: 4, 6 - 10, 29.05.2009

Aydın Kösüş Nermin Kösüş Metin Çapar

Abstract

Erken membran rüptürü olan 36-42 haftalık gebelerde maternal ve fetal sonuçlar

Aydın Köşüş*, Nermin Köşüş*, Metin Çapar**

Özet
Amaç: Erken membran rüptürü (EMR) perinatal sonuçları etkileyen önemli bir obstetrik durumdur. Bu çalışmada EMR nedeniyle takip edilen 36-42 haftalık gebelerde maternal ve fetal sonuçlar incelendi. Gereç ve Yöntem: Çalışmaya 36-42 haftalar arasında EMR gelişen 42 hasta dahil edildi. Hastaların ultrason, lökosit, ateş, CRP, sedimentasyon takipleri yapıldı. Maternal ve fetal faktörler değerlendirilerek hastalar sezaryen yada vajinal yolla doğurtuldu. Bulgular: 36-42 haftalık gebelerde EMR oranı %38,1 olarak tespit edildi. Ortalama yaş 28,2 yıl olarak bulundu. Etiyolojide hastalarda birden fazla neden tesbit edildi. Hastalarda tesbit edilen nedenlerden en belirgin olanları vakaların 19 (%45,2).unda farkedilmemiş doğum başlangıcı, 4 (%9,5).ünde makat geliş, 3 (%7,1).ünde ikiz gebelik, 3 (%7,1).ünde enfeksiyon bulguları şeklinde idi. 3 hastada intrauterin gelişme geriliği (IUGG), 2 hastada geçirilmiş sezaryen, 2 hastada fetal anomali, birer hastada polihidramnios, grandmultiparite, plasenta dekolmanı öne çıkan nedenler olarak tesbit edildi. 3 hastada neden tesbit edilemedi. Hastaların ortalama doğum süresi 37,5 hafta idi. Hastaların 22 (%52,3).si ilk 12 saat içinde, 13 (%30,9).ü ilk 24 saatte, 7 (%16,6).si ilk 1 hafta içinde doğumunu yaptı. 28 (%66,6) hasta vajinal yolla doğurtuldu. Bu hastaların 16 (%57,1) tanesine indüksiyon uygulandı. 14 (%33,4) hastaya sezaryen uygulandı. Hiçbir annede ciddi morbidite yada mortalite gelişmedi. Bebeklerin ortalama doğum kilosu 2509 gr idi. En küçük bebek 1800 gr, en büyük bebek 4300 gr idi. Spontan takip edilen hastalardan birinde bebek mekonyum aspirasyonuna bağlı olarak inutero eks oldu. Bebek 39 haftalık olup 3700 gr ağırlığındaydı. Sonuç: Termde EMR.si olan gebelerde spontan takip esnasında bebekle ilgili morbidite ve mortalite riski artabilir. Bu riskleri engellemek amacıyla hastaların travayda dikkatli bir şekilde takip edilmesi ve beklemeden doğum indüksiyonuna başlanması önemlidir.

Anahtar Sözcükler: Term Gebelik, Erken Membran Rüptürü, Etiyoloji, Tedavi, Perinatal sonuçlar

Abstract

Maternal and fetal outcomes ın premature rupture of membranes between 36-42 weeks

Objectives: Premature rupture of membranes (PROM) effect neonatal mortality and morbidity. Maternal and perinatal outcomes of women with PROM between 36-42 weeks were examined in this study. Material-Methods: Fourty-two women with PROM between 36-42 weeks were taken into the study. Patients were followed by ultrasound, leukocyte count, erythrocyte sedimentation rate (ESR), presence of fever, C-Reactive Protein (CRP). Patients were delivered vaginally or by C-section after evaluation of maternal and fetal factors. Results: Percentage of PROM between 36-42 weeks was found 38.1 %. Mean age was 28.2 years. More than one cause were detected in etiology. The most frequent causes were; unexpected beginning of labour in 19 (45.2%) cases, breech presentation in 4 (9.5%), twin pregnancy in 3 (7.1%) and infection in 3 (7.1%) cases. Three cases had intrauterine growth retardation, 2 had previous C-section, 2 had fetal abnormality, 1 had polyhydramnios, 1 case with grandmultiparity and 1 had decolman placenta. There wasn.t any cause in three cases. Mean delivery week was 37.5 weeks. Delivery was occured in 12 hours in 22 (52.3%) cases, in 24 hours in 13 (30.9%) and in a week in 7 (16.6%) patients. 28 (%66,6) patients were delivered vaginally. Induction of labour with oxytocin was applied to 16 (%57.1) cases. Fourteen (%33.4) patients were delivered by cesarean section. PROM related any maternal morbidity and mortality weren.t seen .Mean birthweight was 2509 grams. Minimum and maximum birthweight were 1800 g and 4300 g respectively. During

Keywords

Term Gebelik, Erken Membran Rüptürü, Etiyoloji, Tedavi, Perinatal sonuçlar

Maternal and fetal outcomes ýn premature rupture of membranes between 36-42 weeks

Abstract

Objectives: Premature rupture of membranes (PROM) effect neonatal mortality and morbidity. Maternal and perinatal outcomes of women with PROM between 36-42 weeks were examined in this study. MaterialMethods: Fourty-two women with PROM between 36-42 weeks were taken into the study. Patients were followed by ultrasound, leukocyte count, erythrocyte sedimentation rate (ESR), presence of fever, C-Reactive Protein (CRP). Patients were delivered vaginally or by C-section after evaluation of maternal and fetal factors. Results: Percentage of PROM between 36-42 weeks was found 38.1 %. Mean age was 28.2 years. More than one cause were detected in etiology. The most frequent causes were; unexpected beginning of labour in 19 (45.2%) cases, breech presentation in 4 (9.5%), twin pregnancy in 3 (7.1%) and infection in 3 (7.1%) cases. Three cases had intrauterine growth retardation, 2 had previous C-section, 2 had fetal abnormality, 1 had polyhydramnios, 1 case with grandmultiparity and 1 had decolman placenta. There wasnt any cause in three cases. Mean delivery week was 37.5 weeks. Delivery was occured in 12 hours in 22 (52.3%) cases, in 24 hours in 13 (30.9%) and in a week in 7 (16.6%) patients. 28 (%66,6) patients were delivered vaginally. Induction of labour with oxytocin was applied to 16 (%57.1) cases. Fourteen (%33.4) patients were delivered by cesarean section. PROM related any maternal morbidity and mortality werent seen .Mean birthweight was 2509 grams. Minimum and maximum birthweight were 1800 g and 4300 g respectively. During spontaneous follow-up one baby was died in utero due to meconium aspiration. The baby was at 39 weeks gestational age and 3700 g. Conclusion: Expectant management in term pregnants having PROM can increase fetal morbidity and mortality. To prevent these, careful follow up of patients during labor and induction of labor without any delay is important.

Keywords

Term pregnancy, Premature rupture of membranes, Etiology, Treatment, Perinatal outcomes

References

• French JI, McGregor JA. The pathobiology of premature rupture of membranes. Semin Perinatol 1996; 20: 344-368
• Lavery JP, Miller CE, Knight RD. The effect of labor on the rheologic response of chorioamniotic membranes. Obstet Gynecol 1982; 60: 87-92
• Bendon RW, Faye-Petersen O, Pavlova Z, Qureshi F, Mercer B, Miodovnik M, et al. Fetal membrane histology in preterm premature rupture of membranes: Comparison to controls and between antibiotic and placebo treatment. The National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network. Pediatr Dev Pathol 1999; 2: 552-8.
• Seo K, McGregor JA, French JI. Infection and premature rupture of membranes. Fetal Med Rev 1990; 2:1-15
• Gabbe SG, Neebly JR, Simphson JL Obstetrics; Normal and problem pregnancies. Third Edition, 1996; 743- 820.
• Scott JR, Disaina J, Hammond CB, Spellacy WN. Danforth’s Obstetrics and Gynecology. Seventy Edition, 1994;305-316.
• Thomas J. Garite, MD. Premature rupture of membranes: The enigma of the obstetrician. Am J Obstet Gynecol 1985;151:1001-1006.
• Eeva MR, Tytti HK, Johanna L, Jukka TU, Marianne KH, Anna LH. Evaluation of a rapid striptest for insülin- like growth factor binding protein-1 in the diagnosis of ruptured fetal membranes, Clinica Chimica Acta 1996; 253:91-101.
• Schutte MF, Treffers PE, Klooterman GJ and Soepatmi S. Management of Premature rupture of membranes. The risk of vaginal examination to the infant. Am J Obstet Gynecol 1983; 146: 395- 400.
• Simhan HN, Canavan TP. Preterm premature rupture of membranes: diagnosis, evaluation and management strategies. BJOG 2005 ;112(1):32-7.
• Ghidini A, Romero R. PROM at term:induction versus expectant management. Contemp Obstet Gynecol 1993; 38: 79-85
• Alcalay M, Hourvitz A, Reichman B, Luski A, Quint J, Barkai G, et al. Prelabour rupture of membranes at term: early induction of labour versus expectant management. Eur J Obstet Gynecol Reprod Biol 1996; 70(2): 129-33
• Akyol D, Mungan T, Unsal A, Yüksel K. Prelabour rupture of the membranes at term--no advantage of delaying induction for 24 hours. 1999;39(3):291-5.
• Yang LC, Taylor DR, Kaufman HH, Hume R, Calhoun B. Maternal and fetal outcomes of spontaneous preterm premature rupture of membranes. 2004 ;104(12):537- 42.
• Egarter C, Leitich H, Karas H, Wieser F, Husslein P, Kaider A, et al. Antibiotic treatment in preterm premature rupture of membranes and neonatal morbidity: a metaanalysis. Am J Obstet Gynecol 1996;174:589-97.
• Mercer BM, Miodovnik M, Thurnau GR, Goldenburg RL, Das AF, Ramsey RD, et al. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. JAMA 1997;278:989-95.
• von Dadelszen P, Kives S, Delisle MF, Wilson RD, Joy R, Ainsworth L, et al. The association between early membrane rupture, latency, clinical chorioamnionitis, neonatal infection, and adverse perinatal outcomes in twin pregnancies complicated by preterm prelabour rupture of membranes. Twin Res 2003; 6(4):257-62.
• Malik AS. Prelabour rupture of membranes and neonatal morbidity in level II nursery in Kelantan. 1994;49(1):12-6.