Normal term gebeliklerdeki umbilikal kord kanı asit-baz değerleri, biyofizik profil ve apgar skorunun uzun dönem nörodevelopmental prognoza etkileri

Yıl 2006, Cilt: 37 Sayı: 1, 1 - 8, 01.02.2006

Alin Başgül Yiğiter Zehra Neşe Kavak Yüksel Yılmaz Hüsnü Gökaslan Ayda Başgül Oylum Tokol Hale Bengisu

Öz

Objective: There has been a long-standing interest in the association between perinatal events and occurence of deficits in children. We conducted a prospective follow-up study of mature infants to search the predictive value of umbilical arterial blood gase and acid-base at delivery, biophysical assessments and Apgar scores on neurodevelopmental outcome of the newborns at two years. Material and Methods: The study included 162 pregnant women with singleton pregnancy after 37 weeks of gestation who attended regularly to our clinic. Biophysical profile assessments (BPP) were performed at 38th gestational age. All of the mothers were healthy and showed no serologic evidence of recent toxoplasmosis, rubella, or syphilis infections. Pregnancies with any obstetric or medical complications (preeclampsia, gestational diabetes etc.) were excluded. Maternal fetal characteristics, labor and delivery variables were recorded. Umbilical arterial blood gas ahdpH were obtained at delivery. Apgar scores at 1 and 5 minutes were assigned. Neurodevelopmental assessment both by using neurologic examination and Denver developmental screening test-2 (DDST-2) standardized for Turkish children were planned to be performed at 2 years. Statistical analyzes used were unpaired student-t test, chi-square test, correlation analyzes and logistic regression analyzes. Results: While the mean pH of the study group was 7.25±0.54, the mean BPP score was 8.55±0.67, Apgar score at 1 minute was 8.25±0.87 and 5 minute Apgar score was found to be 9.58±0.04. Sixty children returned for neurodevelopmental assessment. None of the children who returned for neurologic examination was found to be abnormal. There were fifty-six infants who performed DDST-2 well and scored as "normal". Regression analyzes showed that BPP scores predicted abnormal DDST-2 more accurately than did Apgar scores or pH values. Conclusion: The predictive value of BPP scores performed at term appeared to be stronger than umbilical cord blood gase, acid-base values and Apgar scores at 2 years of age. So, we speculate that BPP performed at term could be an effective and routine assessment which predicts long term neurodevelopmental outcome.

Anahtar Kelimeler

Predictive Value of Tests, Umbilical Arteries, Biophysics, Prospective Studies, Pregnancy, Apgar Score, Term Birth, Fetal Blood, Neurology

Predictive value of umbilical arterial acid-base values, bibophysical profile assessment and apgar score on neurodevelopmental outcome at two years in normal term pregnancies

Öz

Normal Term Gebeliklerdeki Umbilikal Kord Kanı Asit- Baz değerleri, Biyofizik profil ve Apgar Skorunun Uzun Dönem Nörodevelopmental Prognaza Etkileri. Amaç: Normal term gebeliklerde doğum sırasında alman umbilikal arteryal kan gazı değerlerinin, Apgar Skorunun ve termde yapılan biofizikprofil skorlamasmın bu bebeklerin 2 yaşlarındaki nörolojik gelişimlerini tahmin etmedeki rollerini prospektif olarak araştırmayı planladık. Materyal ve Metod: Marmara Üniversitesi Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde prospektif olarak yürütülen bu çalışmaya sistemik bir hastalığı olmayan ve yakın zamanda yapılmış enfeksiyon taramaları normal olarak gelen 37. gebelik haftasının üzerinde 162 tekil gebe hasta dahil edildi. Gebelik sırasında obstetrik ve tıbbi komplikasyon geliştiren gebeler (preeklampsi, gestasyonel diabet, intrauterin gelişme geriliği vb.) çalışmadan çıkarıldı. Bu gebelere 38. gebelik haftasında biyofizik profil testi yapıldı. Doğum odasındaki 1. ve 5. dakika Apgar skorları kaydedildi ve doğumları sırasında umbilikal kord arter kan pH ve asit- baz değerlerine bakıldı. Bu bebeklerin ortalama 2 yaşlarındaki nörolojik gelişimlerinin nörolojik muayene ve nörolojik gelişim testleri yapılarak değerlendirilmesi planlandı. Bulgular: Ortalama 2 yıl sonra çalışmayı tamamlayabilen 60 tane çocuğun nörolojik muayeneleri ve Türk çocuklarına uyarlanmış Denver-2 nörolojik gelişim testleri yapıldı. Çalışma grubunun ortalama pH değeri 7.25±0.54, ortalama Biofizik profil skoru 8.5 5 ±0.6 7, Apgar skorlaması ortalaması 1. dakikada 8.25±0.87 ve beşinci dakikada 9.58±0.04 olarak bulundu. Nörolojik muayenesi yapılan 60 çocukta anormal sonuca rastlanmazken, uygulanan Denver-2 nörolojik gelişim testlerinden, sadece 4 çocukta anormal sonuç alındı. Uzun dönem anormal nörolojik gelişimle umbilikal arter kan pH ve asit-baz değerleri, 1. ve 5. dakika Apgar skorları arasında bir ilişki bulunamadı. Yalnız fetal biyofizik profil nörolojik gelişimi tahmin etmede diğer testlerden daha başarılı olarak bulundu. Sonuç: Termde yapılan biofizik skorlamasmın 2 yaşındaki nörolojik gelişimi tahmin etmedeki değeri, umbilikal kordon kan gazı ve asit-baz değerlerinden ve Apgar Skorlaması değerlerinden daha güçlü gibi gözükmektedir. Fetal Biofizik Profil testinin termdeki tüm gebelere uygulanması bu bebeklerin nörolojik gelişimini tahmin etmede yardımcı olabilecek etkili ve rutin bir uygulama olabilir.

Anahtar Kelimeler

Testlerin kestirim değeri, Umbilikal arterler, Biyofizik, İleriye dönük çalışma, Gebelik, Apgar skoru, Zamanında doğum, Fetal kan, Nöroloji

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