Preeklamptik hastalarda fetal umblikal arter, duktus venosus, middle serebral areter doppler bulgularının incelenmesi
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Dosyalar
Tarih
2011
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Preeklampsi gebeliğin son yarısı boyunca maternal-fetal morbidite ve mortaliteye neden olan, hipertansiyon, proteinüri, yaygın olarak da ödemin eşlik ettiği bir problemdir. Uteroplasental ve fetal dolaşımı saptamak için birçok invazif yöntem kullanılmıştır. Doppler görüntüleme ölçümleri ise maternal ve fetal sirkülasyonu değerlendirmede yeni noninvazif uygulamalardır. Uterin arterler, umblikal damarlar, fetal arterler ve venlerde akım araştırması ile preeklamptik grupla sağlıklı gebeler arasındaki farklılıkların tesbiti ile renkli doppler ultrasonografi yaygın kullanılır hale getirmiştir. Özellikle yüksek riskli gebelerde kullanımı, obstetrik sonuçları iyileştirmeyi ve perinatal morbiditeyi azaltmayı vaat etmektedir (94). Uterin arterler ve umblikal arterler plasenta için, venöz dopplerler detaylı kardiyovasküler durum ve solunum sistemi durumunun değerlendirilmesi için gerekli komponentlerdir (85). Middle serebral arter (MCA) sistemik arteryel özellikleri göstermek, gerekli durumlarda beyin koruyucu etkiyi anlamak için kullanılır. Serebroplasental oran (MCA/UA oranları) ise esasen doğuma yakın gebeliklerde UA ölçümleri normal değerlendirilenlerde kötü perinatal sonuçları tahmin ederek, bunları iyileştirmek amacıyla kullanılır. Duktus venosus doppleri ise kardiak fonksiyonları yansıtan, dopplerde en son bozulan parametredir. Klinik, prospektif ve gözlemsel olarak dizayn edilen bu çalışmaya, Selçuk Üniversitesi Meram Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği' nde takip edilen, ilk defa gebeliğin 20. haftasından sonra tansiyon yüksekliği oluşan ve öncesinde proteinürisi olmayıp, tansiyon yüksekliği sonrası proteinüri saptanarak preeklampsi tanısı alan hastalarla, preeklamptiklerin yaş ve gebelik haftalarına uygun olarak oluşturulan tansiyon ölçümleri normal olan ve proteinürisi olmayan gebeler dahil edildi. Fetal anomalisi, multipl gebeliği olanlar çalışmaya dahil edilmedi. Fetüslerden umblikal arter ( ölçümü amnion sıvısı içerisinde fetüs ve plasentadan uzak bir segmenttten), orta serebral arter ( mezensefalon düzeyinden geçen transvers düzlemde Willis poligonu bulunarak), duktus venosus dopplerleri ( karaciğer içinden umblikal ven takip edilerek VCI'a dökülmeden önce, fetal sonlumun olamadığı bir anda) hesaplandı. UA ve MCA PI ve RI değerleri oranlanarak, serebroplasental durum değerlendirildi. Bulunan diğer doppler bulguları; gebelik haftalarında olması gereken persentillere göre; duktus venosus ise `a' dalga durumuna göre değerlendirildi. Toplanan tüm veriler SPSS 18.0 programına yüklendi, uygun istatistiksel yöntemlerle değerlendirildi. Kontrol ve preeklamptikler arasındaki doppler değerleri karşılaştırıldı. Bu testlerde 'p' değerinin 0.05 değerinin altında olduğu sonuçlar istatistiksel olarak anlamlı kabul edildi. Çalışmaya 43 kontrol, 43 preeklamptik hasta olmak üzere, toplam 86 gebe alındı. Kontrol grubunun yaş ortalamaları 28.48±6,18, preeklamptik grubun ise 30,27±6,90 idi. Gebelik haftaları ortalaması kontrol grubunda 36,02 ±3,58, preeklamptik grupta 34,86 ± 3,73 olarak hesaplandı. Doppler bulguları karşılaştırıldığında, preeklamptik grupta doppler bulgularının patolojikliği ile kontrol grubu arasında anlamlı fark olduğu görüldü (her biri için p<0,05). Aynı zamanda çalışmamızda preeklampsi şiddeti ile doppler bulguları karşılaştırıldığında, preeklampsi şiddeti arttıkça doppler bulgularında anormallik tesbit etme oranı yükselmekteydi. Bununla birlikte doppler bulgusu anormal olan hastalarda postnatal fetal sonuçlar değerlendirildiğinde; mekonyum, 1. ve 5. dakika apgar skorlarında düşüklük ve bebeklerin yenidoğan yoğun bakımda takibini tesbit etme açısından, doppler anormalliğinin spesifitesi düşüktü. Çalışmamız bize dopplerin daha çok preeklampsi şiddeti ile uyumlu olduğunu, fakat postnatal öngörüde yetersiz kaldığını göstermektedir. Bunu da çalışmamızdaki preeklamptik gebelerin fetal durum bozukluğu oluşmadan veya artmadan, preeklamptik gebeliklerin daha çok maternal nedenlerden ötürü sonlandırıldığı sonucuna götürmektedir. Postnatal fetal sonucu öngörmek için dopplere başka parametreleri eklemek gerektiğini düşünmekteyiz.
Preeclampsia is a problem that is associated with hypertension, proteinuria, and diffused oedema that causes maternal-fetal morbidity and mortality during the second half of pregnancy. Many invasive methods are used to determine the uteroplacental and fetal circulation. Doppler imaging is a new non-invasive application for the evaluation of maternal and fetal circulation. Color Doppler ultrasound has become widely used for the evaluation of blood flow in uterine arteries, umbilical vessels, fetal arteries and veins to determine the differences between healthy pregnant and preeclamptic women. It is especially promising in improving obstetric and perinatal morbidity in high-risk pregnant women (175). Uterine arteries and umbilical arteries (UA) and detailed venous Doppler of the placenta are necessary components to assess the status of cardiovascular and respiratory status (120). Middle cerebral artery (MCA) shows the systemic arterial properties, and when necessary it is used to understand the brain sparing effect. Cerebroplasental ratio (MCA / UA ratio) close to the delivery is used for estimating poor perinatal results to improve outcomes of pregnancies being considered by the normal measurements of UA. Ductus venosus Doppler reflects the cardiac function and it is the last deteriorating Doppler parameter. This study was designed as clinical, prospective and observational study. Patients followed up in Selcuk University Meram Medical Faculty, Department of Obstetrics and Gynecology who were diagnosed as preeclampsia because they had hypertension for the first time after 20th week of pregnancy and proteinuria that developed after hypertension and it was not present before and normal patients who had blood pressure in accordance to the gestational weeks were included in the measurements. Patients with fetal anomaly, multiple pregnancy, metabolic disease were not included in the study. Umbilical artery of the fetus (measurement inside amniotic fluid in a segment away from the fetus and placenta), middle cerebral artery (in a transverse plane at the level of mesencephalon with finding Circle of Willis), ductus venosus doppler (following the umbilical vein through the liver before emptying into IVC in the absence of fetal respiration) were measured.Cerebroplacental situation was evaluated by rating UA and MCA PI and RI values. Other Doppler findings S / D, PI and RI were evaluated according to percentile of gestational weeks in the norm curves; ductus venosus was assessed according to the state of 'a' wave. All collected data were loaded to SPSS 18.0 program; the appropriate statistical methods were used in analysis. Doppler values were compared between the control and preeclamptic patients. In these tests the 'p' value of less than 0.05 was considered statistically significant. A toplam of 86 pregnant women: 43 controls, 43 preeclamptic patients were included in the study. The mean age of the control group was 28.48 ± 6.18, and that of preeclamptic group was 30.27 ± 6.90. The mean gestational ages were 36.02 ± 3.58 and 34.86 ± 3.73 in the control group and preeclamptic group respectively. In comparison of pathologic Doppler findings, significant difference was found between two groups (for each p <0.05). At the same time when we compared Doppler findings with the severity of preeclampsia, with increasing severity of preeclampsia the rate of abnormal Doppler findings were increased. However, the specificity of Doppler abnormality in determining postnatal fetal outcome: presence of meconium, 1st and 5th minute Apgar scores, neonatal intensive care unit admission was low. Our study shows that Doppler is more consistent with the severity of preeclampsia but it is insufficient for postnatal predictions. Our study finds that preeclamptic pregnancies are terminated for more maternal reasons before deterioration of fetal condition. We think that other parameters should be added to fetal doppler to predict the Postnatalresult suggest.
Preeclampsia is a problem that is associated with hypertension, proteinuria, and diffused oedema that causes maternal-fetal morbidity and mortality during the second half of pregnancy. Many invasive methods are used to determine the uteroplacental and fetal circulation. Doppler imaging is a new non-invasive application for the evaluation of maternal and fetal circulation. Color Doppler ultrasound has become widely used for the evaluation of blood flow in uterine arteries, umbilical vessels, fetal arteries and veins to determine the differences between healthy pregnant and preeclamptic women. It is especially promising in improving obstetric and perinatal morbidity in high-risk pregnant women (175). Uterine arteries and umbilical arteries (UA) and detailed venous Doppler of the placenta are necessary components to assess the status of cardiovascular and respiratory status (120). Middle cerebral artery (MCA) shows the systemic arterial properties, and when necessary it is used to understand the brain sparing effect. Cerebroplasental ratio (MCA / UA ratio) close to the delivery is used for estimating poor perinatal results to improve outcomes of pregnancies being considered by the normal measurements of UA. Ductus venosus Doppler reflects the cardiac function and it is the last deteriorating Doppler parameter. This study was designed as clinical, prospective and observational study. Patients followed up in Selcuk University Meram Medical Faculty, Department of Obstetrics and Gynecology who were diagnosed as preeclampsia because they had hypertension for the first time after 20th week of pregnancy and proteinuria that developed after hypertension and it was not present before and normal patients who had blood pressure in accordance to the gestational weeks were included in the measurements. Patients with fetal anomaly, multiple pregnancy, metabolic disease were not included in the study. Umbilical artery of the fetus (measurement inside amniotic fluid in a segment away from the fetus and placenta), middle cerebral artery (in a transverse plane at the level of mesencephalon with finding Circle of Willis), ductus venosus doppler (following the umbilical vein through the liver before emptying into IVC in the absence of fetal respiration) were measured.Cerebroplacental situation was evaluated by rating UA and MCA PI and RI values. Other Doppler findings S / D, PI and RI were evaluated according to percentile of gestational weeks in the norm curves; ductus venosus was assessed according to the state of 'a' wave. All collected data were loaded to SPSS 18.0 program; the appropriate statistical methods were used in analysis. Doppler values were compared between the control and preeclamptic patients. In these tests the 'p' value of less than 0.05 was considered statistically significant. A toplam of 86 pregnant women: 43 controls, 43 preeclamptic patients were included in the study. The mean age of the control group was 28.48 ± 6.18, and that of preeclamptic group was 30.27 ± 6.90. The mean gestational ages were 36.02 ± 3.58 and 34.86 ± 3.73 in the control group and preeclamptic group respectively. In comparison of pathologic Doppler findings, significant difference was found between two groups (for each p <0.05). At the same time when we compared Doppler findings with the severity of preeclampsia, with increasing severity of preeclampsia the rate of abnormal Doppler findings were increased. However, the specificity of Doppler abnormality in determining postnatal fetal outcome: presence of meconium, 1st and 5th minute Apgar scores, neonatal intensive care unit admission was low. Our study shows that Doppler is more consistent with the severity of preeclampsia but it is insufficient for postnatal predictions. Our study finds that preeclamptic pregnancies are terminated for more maternal reasons before deterioration of fetal condition. We think that other parameters should be added to fetal doppler to predict the Postnatalresult suggest.
Açıklama
Anahtar Kelimeler
Akım sitometrisi, Flow cytometry, Fetal monitoring, Gebelik, Pregnancy, Hipertansiyon, Hypertension, Preeklampsi, Pre-eclampsia, Doppler ultrasonografi, Doppler ultrasonography
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Göktepe, H. (2011). Preeklamptik hastalarda fetal umblikal arter, duktus venosus, middle serebral areter doppler bulgularının incelenmesi. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
