Son 10 Yılda Kliniğimizde Yapılan Serklajların Retrospektif Değerlendirilmesi
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Tarih
2022
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Hastanemizde son 10 yılda yapılan serklajların retrospektif değerlendirilmesi ile proflaktik ve acil serklajların; servikal yetmezliğin risk faktörleri, hastanın demografik özellikleri gibi çeşitli yönlerle ele alınarak serklajın obstetrik sonuçlar üzerine etkilerinin karşılaştırılmasıdır.
Yöntem: Hastanemizde son 10 yıl içinde yapılan serklajlar retrospektif olarak hastanenin elektronik kayıt sisteminden ve arşivdeki hasta dosyaları üzerinden tarandı. Çalışmaya çoğul gebelikler fetal anomalisi olanlar ve Mc Donald Tekniği dışında yapılan serklajlar dahil edilmedi. Öyküye ve ultrasonografik bulgulara bağlı serklajlar proflaktik, fizik muıayeneye bağlı serklajlar acil serklaj olarak kabul edildi.Hastaların yaşı boyu kilosu beden kitle indeksi serklajın gebeliğin kaçıncı haftasında yapıldığı ek hastalık varlığı geçirilmiş cerrahi öyküsü gravide parite yaşayan çocuk sayısı abortus sayısı intrauterın mort fetüs ivf öyküsü geçirilmiş konizasyon Denklemi buraya yazın.öyküsü herhangi bir sebeple geçirilmiş servikal dilatasyon öyküsü mevcut doğumun şekli doğumun haftası apgar ve doğum kilosu vb sorgulandı
Bulgular: Erken doğum öyküsü var olan hasta oranı proflaktik serklaj yapılan hasta grubunda acil serklaj yapılan hasta grubuna göre anlamlı olarak daha yüksek izlendi (p<0.05). %84.3’e karşı %48.1. Geçirilmiş serklaj öyküsü oranı proflaktik serklaj yapılan hasta grubunda acil serklaj yapılan hasta grubuna göre anlamlı olarak daha yüksek izlendi (p<0.05).%44.1’e karşı %9.3. Ortalama servikal uzunluk proflaktik serklaj yapılan grupta ortalama 30.44 mm iken acil serklaj yapılan grupta ortalama 18.84 mm olarak bulunmuş olup bu fark istatistiksel olarak anlamlı bulundu(p<0.05).
Servikal muayene esnasında fuenniling tespit edilen hasta oranı acil serklaj yapılan grupta %27.8 olup proflaktik serklaj yapılan grupta %0 olarak tespit edildi .Bu fark istatiksel olarak anlamlı bulundu (p<0.05) Doğum haftası açısından karşılaştırıldığında proflaktik serklaj yapılan hasta grubunda ortalama doğum haftası 35.17, acil serklaj yapılan hasta grubunda ortalama 30.77 olarak bulunmuş olup proflaktik serklaj yapılan hasta grubunda serklajdan doğuma kadar geçen sürenin daha uzun olduğu tespit edildi. Bu fark istatistiksel olarak anlamlıdır.(p<0.05) Doğum ağırlığı proflaktik serklaj yapılan hasta grubunda ortalama 2686.37 gr acil serklaj yapılan hasta grubunda ortalama 1910 gr olarak tespit edilmiştir bu fark istatistiksel olarak anlamlı bulundu. .(p<0.05) 5. dakika APGAR skoru karşılaştırıldığında proflaktik serklaj yapılan hasta grubunda ortalama 6.04 iken acil serklaj yapılan hasta grubunda ortalama 4.5 olarak tespit edilmiş olup bu oran istatistiksel olarak anlamlı idi. .(p<0.05)
Sonuç:Çalışmamızda proflaktik serklaj yapılan servikal yetmezlik açısından yüksek riskli gebelerde acil serklaj yapılan hastalara göre doğuma kadar geçen süre daha uzun APGAR ve doğum kiloları daha tatmin edici sonuçlar vermiştir.
Objective: With the retrospective evaluation of cerclages performed in our hospital in the last 10 years, prophylactic and emergency cerclages; the aim of this study is to compare the effects of cerclage on obstetric outcomes by considering various aspects such as risk factors of cervical insufficiency and demographic characteristics of the patient. Materials and Methods: Cerclages performed in our hospital in the last 10 years were scanned retrospectively from the hospital's electronic registry system and patient files in the archive. Multiple pregnancies, those with fetal anomaly and cerclages performed other than McDonald Technique were not included in the study. Cerclages based on history and ultrasonographic findings were considered prophylactic, cerclages based on physical examination were accepted as emergency cerclages. Age, weight, body mass index, presence of additional disease in which week of pregnancy the cerclage was performed, previous history of surgery, number of children with parity in gravida, number of abortions, intrauterine mort fetus, history of IVf, past conization history of cervical dilatation for any reason present type of delivery week of delivery apgar and birth weight etc. Results: The rate of patients with a history of preterm delivery was significantly higher in the prophylactic cerclage group than in the emergency cerclage group (p<0.05). 48.1% versus 84.3%. The rate of previous cerclage history was significantly higher in the prophylactic cerclage group than in the emergency cerclage group (p<0.05). 44.1% vs. 9.3%. While the mean cervical length was 30.44 mm in the prophylactic cerclage group, it was 18.84 mm in the emergency cerclage group, and this difference was statistically significant (p<0.05). The rate of patients in whom fuenniling was detected during cervical examination was 27.8% in the emergency cerclage group and 0% in the prophylactic cerclage group. This difference was statistically significant (p<0.05). In the group of patients who underwent emergency cerclage, the mean was found to be 30.77, and it was determined that the time from cerclage to delivery was longer in the group of patients who underwent prophylactic cerclage. This difference is statistically significant. (p<0.05) The average birth weight was 2686.37 g in the prophylactic cerclage group and 1910 g in the emergency cerclage group, and this difference was statistically significant. .(p<0.05) When the 5th minute APGAR score was compared, the mean was 6.04 in the prophylactic cerclage group, while it was 4.5 in the emergency cerclage group, and this rate was statistically significant. .(p<0.05) Conclusion: In our study, the time to delivery was longer in pregnant women with high risk for cervical insufficiency who underwent prophylactic cerclage compared to the patients who underwent emergency cerclage, and their APGAR and birth weights gave more satisfactory results.
Objective: With the retrospective evaluation of cerclages performed in our hospital in the last 10 years, prophylactic and emergency cerclages; the aim of this study is to compare the effects of cerclage on obstetric outcomes by considering various aspects such as risk factors of cervical insufficiency and demographic characteristics of the patient. Materials and Methods: Cerclages performed in our hospital in the last 10 years were scanned retrospectively from the hospital's electronic registry system and patient files in the archive. Multiple pregnancies, those with fetal anomaly and cerclages performed other than McDonald Technique were not included in the study. Cerclages based on history and ultrasonographic findings were considered prophylactic, cerclages based on physical examination were accepted as emergency cerclages. Age, weight, body mass index, presence of additional disease in which week of pregnancy the cerclage was performed, previous history of surgery, number of children with parity in gravida, number of abortions, intrauterine mort fetus, history of IVf, past conization history of cervical dilatation for any reason present type of delivery week of delivery apgar and birth weight etc. Results: The rate of patients with a history of preterm delivery was significantly higher in the prophylactic cerclage group than in the emergency cerclage group (p<0.05). 48.1% versus 84.3%. The rate of previous cerclage history was significantly higher in the prophylactic cerclage group than in the emergency cerclage group (p<0.05). 44.1% vs. 9.3%. While the mean cervical length was 30.44 mm in the prophylactic cerclage group, it was 18.84 mm in the emergency cerclage group, and this difference was statistically significant (p<0.05). The rate of patients in whom fuenniling was detected during cervical examination was 27.8% in the emergency cerclage group and 0% in the prophylactic cerclage group. This difference was statistically significant (p<0.05). In the group of patients who underwent emergency cerclage, the mean was found to be 30.77, and it was determined that the time from cerclage to delivery was longer in the group of patients who underwent prophylactic cerclage. This difference is statistically significant. (p<0.05) The average birth weight was 2686.37 g in the prophylactic cerclage group and 1910 g in the emergency cerclage group, and this difference was statistically significant. .(p<0.05) When the 5th minute APGAR score was compared, the mean was 6.04 in the prophylactic cerclage group, while it was 4.5 in the emergency cerclage group, and this rate was statistically significant. .(p<0.05) Conclusion: In our study, the time to delivery was longer in pregnant women with high risk for cervical insufficiency who underwent prophylactic cerclage compared to the patients who underwent emergency cerclage, and their APGAR and birth weights gave more satisfactory results.
Açıklama
Anahtar Kelimeler
proflaktik serklaj, prophylactic cerclage, acil serklaj, emergency cerclage, servikal yetmezlik, cervical insufficiency, obstetrik sonuçlar, obstetric outcomes, preterm doğum, preterm delivery.
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Künye
Akıncı, D. (2022). Son 10 Yılda Kliniğimizde Yapılan Serklajların Retrospektif Değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Kadın Hastalıkları ve Doğum Anabilim Dalı, Konya.
