Multifetal redüksiyon ve selektif terminasyon yapılan olguların sonuçları
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Dosyalar
Tarih
2018
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada kliniğimizde çoğul gebeliklere uygulanan fetal redüksiyon (FR) ve selektif terminasyon (ST) işlemlerinin komplikasyonlarının ve gebelik sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Çalışmaya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalında Ocak 2007 ile Haziran 2017 tarihleri arasında FR ve ST uygulanan çoğul gebelikler dahil edilmiştir. FR ve ST yapılan ve fakat çeşitli nedenlerle (başka bir merkezde doğum yapması, dosya kayıtlarından hastalara ulaşılamaması, ulaşılan hastaların çalışmada kullanılacak verilerinin eksik olması, çalışmaya katılmak istememeleri) verileri yeterli olmayan hastalar çalışmaya dahil edilmemiştir. FR ve ST yapılan hastaların yaşları, gravida, parite, abortus ve yaşayan çocuk sayısı, kan grupları, gebeliklerin şekli (spontan mı yoksa tedaviyle mi oluştuğu), tedavi ile oluştuysa hangi tür yardımcı üreme tekniklerinin kullanıldığı, işlemin yapıldığı gebelik haftası, işlem öncesi ve sonrası fetüs sayısı, doğum şekli¸ doğum haftası, sezaryen endikasyonları ile antenatal dönemde gelişen komplikasyonlar değerlendirildi. Ayrıca işleme bağlı gebelik kaybı değerlendirildi. Doğum sonrası bebeğin APGAR skoru, cinsiyeti, doğum ağırlığı, yenidoğan yoğun bakıma alınma gereksinimi değerlendirildi. İşlem yaptıran gebenin işlem sonrası pişmanlık durumu da sorgulandı. Bulgular: Çalışmaya FR ve ST yapılan 228 gebeden çeşitli nedenlerle (başka bir merkezde doğum yapması, dosya kayıtlarından hastalara ulaşılamaması, ulaşılan hastaların çalışmada kullanılacak verilerinin eksik olması, çalışmaya katılmak istememeleri) 72'si çalışma dışı bırakılmıştır. Çalışmaya, çalışma amacına uygun verilerin tamamına ulaşılabilen 156 hasta alındı. Bu gebelerden 132 tanesine FR, 24 tanesine ST uygulanmıştır. FR yapılan ortalama gebelik haftası 11,7 (±1,3) idi. ST yapılan ortalama gebelik haftası ise 14,0 (±3,1) idi. ST yapılan gebelik haftası FR yapılan gebelik haftasına göre anlamlı olarak daha büyüktü (p<0,001). FR yapılan toplam 132 gebelikten birinde (%0,75) gebelik total olarak kaybedilmiştir. Bu dördüz gebelikten ikiz gebeliğe redükte edilen bir gebedir. ST yapılan gebeliklerin hiçbirinde gebelik kaybı olmamıştır (%0 [0/24]). FR yapılan gebeliklerin %82,4'ü (108/131) sezaryen ile doğum yaparken %17,6'sı (24/131) vajinal yolla doğum yapmıştır. ST yapılan olguların %34'ü (8/24) vajinal yolla doğum yaparken, %66'sı (16/24) sezaryen ile doğurmuştur. Tekil gebeliğe redükte edilen FR ve ST olguları karşılaştırıldığında 37 hafta altında ve 32 hafta altında doğum açısından anlamlı fark izlenmedi (p:0,27). Tekil gebeliğe redükte edilen FR ve ST olguları karşılaştırıldığında 2500 gr altı ve 1500 gr altı doğum ağırlıkları açısından anlamlı fark izlenmedi (p:0,29). Tekil gebeliğe redükte edilen FR ve ST olguları karşılaştırıldığında yenidoğan yoğun bakım ünitesine alınan fetus sıklığı arasında fark görülmedi (p:0,75). FR yapılan anneler ile görüşüldüğünde fetal redüksiyon yaptırdıkları için pişman olup olmadıkları ile ilgili soruya gebelerin %20,4'ü pişman olduğunu söylemiştir. ST yapılan anneler ile görüşüldüğünde ise ST yaptırdıkları için pişman olup olmadıkları ile ilgili soruya %4,1'i pişman olduğunu söylemiştir. Her iki grup karşılaştırıldığında FR yaptıran gebelerin ST yaptıranlara göre daha fazla pişmanlık duyduğu ve bu farkın da istatistiksel olarak anlamlı olduğu görülmüştür (p<0,05). Sonuç: FR ve ST uygulanan gebelerin indirgenen fetüs sayısında devam eden gebeliklerle uyumlu olarak fetal mortalite ve morbidite açısından gebelik sonuçlarını iyileştirmede başarılı yöntemler olduğu sonucuna varılmıştır.
In this study, we aimed to evaluate complications and pregnancy outcomes of fetal reduction (FR) and selective termination (ST) procedures applied to multifetal pregnancies in our clinic. Materials and Methods: Our study included patients with multifetal pregnancies whom were applied ST and FR between January 2007 and June 2017 inNecmettin Erbakan University Meram Medical Faculty, Department of Obstetrics and Gynecology. Patients who have undergone FR and ST whose data were not sufficient (given birth at another center, unable to reach the patient from the file records, lack of data on, and some patients refusal to participate the research) were not included in the study. The age of the patients with FR and ST, the number of gravida, parity, abortus and living children, blood types, the method of becoming pregnant (whether spontaneous or medically assisted), if medically assisted, what kind of techniques were used, the gestational week, the number of fetuses before and after the procedure, indications of cesarean section and complications developed during antenatal period were evaluated. Loss of pregnancy due to FR and ST was also evaluated. After birth, data of APGAR score, gender, birth weight, necessity of intensive care for newborns were evaluated. The post-procedural remorse of the patient was questioned. Results: Of the 228 patients who underwent FR and ST studies, 72 were excluded from the study for various reasons (given birth at another center, unable to reach the patient from the file records, lack of data on, and some patients who did not want to participate the research). Of the 156 patients who were included 132 were treated with FR and 24 with ST. The mean gestational week of patıents whom underwent FR was 11.7 (± 1.3) and ST was 14,0 (±3,1). Gestational week was significantly higher in ST-treated patients than compared to FR-treated patients (p<0.001). In 132 patients whom were FR-treated, total loss of pregnancy was one (0.75%), this occured in a patient of quadruped pregnancy to twin pregnancy reduction. No pregnancy loss occurred in ST pregnancies (0% [0/24]). 82,4% (108/131) of pregnancies with FR were delivered with cesarean section and 17,6% (24/131) delivered by vaginal route. 34% (8/24) of the cases with ST were delivered by vaginal route and 66% (16/24) with cesarean section. When FR and ST cases that were reduced to single pregnancy were compared, no significant difference was observed between birth weight and 37 weeks under 32 weeks (p: 0.27). There was no significant difference in birth weights among fetuses of below 2500 gr and below 1500 gr when FR and ST cases that were reduced to single pregnancy were compared (p: 0,29). There was no difference in the frequency of neonatal intensive care unit requirement compared with the cases of FR and ST to single pregnancy (p: 0,75). The question of whether they regretted having fetal reduction when they were interviewed with, the FR mothers stated that % 20.4 of the pregnant women were regretful. When the parents were questioned about their ST decision, 4,1% of them said that they regretted whether they made a decision about having ST permission. When comparing the two groups, it was found that the pregnant women who got the FR had more regrets than the ST patients and this difference was statistically significant (p <0,05). Results: It has been concluded that pregnancies with FR and ST are successful methods to improve pregnancy outcomes in terms of fetal mortality and morbidity in line with pregnancies continuing in the number of fetuses being reduced.
In this study, we aimed to evaluate complications and pregnancy outcomes of fetal reduction (FR) and selective termination (ST) procedures applied to multifetal pregnancies in our clinic. Materials and Methods: Our study included patients with multifetal pregnancies whom were applied ST and FR between January 2007 and June 2017 inNecmettin Erbakan University Meram Medical Faculty, Department of Obstetrics and Gynecology. Patients who have undergone FR and ST whose data were not sufficient (given birth at another center, unable to reach the patient from the file records, lack of data on, and some patients refusal to participate the research) were not included in the study. The age of the patients with FR and ST, the number of gravida, parity, abortus and living children, blood types, the method of becoming pregnant (whether spontaneous or medically assisted), if medically assisted, what kind of techniques were used, the gestational week, the number of fetuses before and after the procedure, indications of cesarean section and complications developed during antenatal period were evaluated. Loss of pregnancy due to FR and ST was also evaluated. After birth, data of APGAR score, gender, birth weight, necessity of intensive care for newborns were evaluated. The post-procedural remorse of the patient was questioned. Results: Of the 228 patients who underwent FR and ST studies, 72 were excluded from the study for various reasons (given birth at another center, unable to reach the patient from the file records, lack of data on, and some patients who did not want to participate the research). Of the 156 patients who were included 132 were treated with FR and 24 with ST. The mean gestational week of patıents whom underwent FR was 11.7 (± 1.3) and ST was 14,0 (±3,1). Gestational week was significantly higher in ST-treated patients than compared to FR-treated patients (p<0.001). In 132 patients whom were FR-treated, total loss of pregnancy was one (0.75%), this occured in a patient of quadruped pregnancy to twin pregnancy reduction. No pregnancy loss occurred in ST pregnancies (0% [0/24]). 82,4% (108/131) of pregnancies with FR were delivered with cesarean section and 17,6% (24/131) delivered by vaginal route. 34% (8/24) of the cases with ST were delivered by vaginal route and 66% (16/24) with cesarean section. When FR and ST cases that were reduced to single pregnancy were compared, no significant difference was observed between birth weight and 37 weeks under 32 weeks (p: 0.27). There was no significant difference in birth weights among fetuses of below 2500 gr and below 1500 gr when FR and ST cases that were reduced to single pregnancy were compared (p: 0,29). There was no difference in the frequency of neonatal intensive care unit requirement compared with the cases of FR and ST to single pregnancy (p: 0,75). The question of whether they regretted having fetal reduction when they were interviewed with, the FR mothers stated that % 20.4 of the pregnant women were regretful. When the parents were questioned about their ST decision, 4,1% of them said that they regretted whether they made a decision about having ST permission. When comparing the two groups, it was found that the pregnant women who got the FR had more regrets than the ST patients and this difference was statistically significant (p <0,05). Results: It has been concluded that pregnancies with FR and ST are successful methods to improve pregnancy outcomes in terms of fetal mortality and morbidity in line with pregnancies continuing in the number of fetuses being reduced.
Açıklama
Anahtar Kelimeler
Çoğul gebelik, Multiple pregnancy, Fetal redüksiyon, Fetal reduction, Multifetal gebelik, Multifetal pregnancy, Selektif terminasyon, Selective termination
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Sarıkaya, S. (2018). Multifetal redüksiyon ve selektif terminasyon yapılan olguların sonuçları (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Kadın hastalıkları ve Doğum Anabilim Dalı, Konya.
