Vücut ağırlığı 250 kilo olan miadında spontan gebelik: Bir olgu sunumu

16 haftalık gebeliği tespit edilen 35 yaşındaki hasta kliniğimize başvurdu. Hastanın 2. gebeliği olup önceki gebeliğinin 5 yıl önce miadında spontan vajinal doğumla sonlandığı öğrenildi. Hasta ileri derecede obez ve yürümekte güçlük çekiyordu. Pelvik muayenesi normal idi. Kilo 232 Kg, Body Mass Index (BMD): 78.4 kg/m2, boy: 172 cm, tansiyon arteriyel 130/85 mmHg, Nb. 78/dk, A: 36.8C idi. Güçlükle yapılan ultasonogratide uterin kavitede 16 haftalık fetal kalp hareketi olan tek fetus izlendi. Laboratuvar incelemesi normal sınırlarda olan hastaya obesitesinden dolayı gelişebilecek riskler anlatılarak takibe alındı. 24. haftada 50 gr glukoz tarama testi yapıldı. Tarama testi sonucu 150 gr/dl gelmesi üzerine Oral GlukozTolerans Testi (OGTT) yapıldı. OGTT sonucu bozuk olan hastaya diyet başlandı ve takibe alındı. Takip süresi boyunca başka bir sorun gel işmedi. Gebelik yaşı 38 hafta 5 gün olan hasta sancılarının başlaması üzerine kliniğimize başvurdu. Yapılan incelemede kilo 250 kg, BMD: 84.5 kg/m2, TA: 140/95, Nb:84, A: 36.2C idi. Güçlükle yapılan ultrasonografide 4200gr kilo tahmini ve fetal kalp hareketi olan makat prezentasyonda fetus izlendi. Laboratuvar incelemesi normal sınırlardaydı. Güçlükle yapılan vajinal tuşede servikal dilatasyon 3 cm olarak saptandı ve hastaya sezaryen önerildi. Gerekli hazırlıklar yapılarak hasta sezaryene alındı. 4 kişilik ekibin katıldığı operasyon güçlükle gerçekleştirilebildi. Batını güçlükle kapatılan ve yaklaşık 1.5 saat süren operasyon sonunda hasta takibe alındı. Postoperatif 3.günde keşi yeri enfeksiyonu gel işen hastaya uygun antibiyotik başlandı. Postoperatif 10. günde hasta sorunsuz bir şekilde taburcu edildi.

A 35 year old patient in 16th week of pregnancy has admitted our clinic. It was the second pregnancy of the patient, and it was learned that the latter pregnancy ended with term spontaneous vaginal delivery 5 years ago. The patient was obese and she was suffering from walking. The pelvic examination was normal. Weight was 232kgs, Body Mass Index (BMD): 78.4 kg/m2, height was 1 72cm, arteriel tension was 130/85mmHg, pulse was 78/min, 16 week old heart movement was detected in uterine cavity in hardly done ultrasonography. The patient whose labaratory evaluation was with in normal limits was taken under follow up, and she was informed about the risks due to her obesity. 50 grs glucose screening test was performed in 24th week. Oral Glucose Tolerance Test (OGTT) w as performed since screening test result was above 150gr/dl. The patient was put on diet since OGTT result was abnormal and she was taken under control. No other complaint has developed during follow up. Patient has admitted to our clinic with the begining of her contractions in the 38th week and 5 day of her pregnancy. In her evaluation weight was 250kgs, BMD: 84.5 kg/m2, tension was 140/95mmHg, pulse was 84/min., fever 36.2°C. In the hardly done ultrasonography of the patient, a fetus weighed 4200grs and with fetal cardiac activity and who was in breech presentation. Labaratory evaluation was within normal limits. In the hardly performed vaginal examination the servical dilatation of the patient was 3cms and cesserean section was offered to the patient. The patient has been taken under cesserean section with needed precautions. The operation was performed hardly with 4 persons. The abdomen was hardly closed and patient was followed up after an operation lasted 1.5 hours. In the third postoperative day of the patient wound infection has developed and appropriate antibiotic theraphy was started. The patient was externed in the 10th day of operation with no problem.