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Geçirilmiş Sezaryen Öyküsü Olan Hastalarda İkinci Trimester Tarama Testi Biyokimyasal Belirteçlerinin Kötü Gebelik Sonuçlarıyla İlişkisi

Year 2022, Volume: 14 Issue: 1, 11 - 15, 30.04.2022
https://doi.org/10.35514/mtd.2022.61

Abstract

Amaç: Geçirilmiş sezaryen öyküsü olan hastalarda ikinci trimesterde bakılan maternal serum Alfa-fetoprotein (AFP), insan koryonik gonadotropin (HCG) ve serbest estriol (uE3) seviyeleri ile kötü gebelik sonuçları arasındaki ilişkiyi incelemek, kötü gebelik sonuçlarını öngörmede etkili olup olmadığını değerlendirmek ve geçirilmiş sezaryen öyküsü olan ve olmayan gebeleri bu belirteçler açısından kıyaslamak.
Materyal-Metotlar: Gebelik takipleri aynı klinikte yapılmış, geçirilmiş uterin cerrahisi olup sezaryen doğum yapan gebeler (n=87) ve normal spontan doğum yapan (n=105) gebelerin verileri retrospektif olarak değerlendirildi. Gebelerin yapılmış olan ikinci trimester taraması testinin kapsadığı biyokimyasal belirteçlerden AFP, HCG ve uE3 düzeyleri ve düzeltilmiş medyan katları (MoM-multiples of median) değerleri değerlendirilmeye alındı. Biyokimyasal belirteçlerin değerelerinin gruplar arasındaki farkı ve kötü maternal-fetal sonuçlarla ilişkisi değerlendirildi.
Bulgular: İkinci trimester tarama testi belirteçlerinden AFP, HCG ve uE3 seviyelerinde, gruplar arasında istatistiksel olarak anlamlı bir fark bulunmamıştır. Her iki grup birlikte değerlendirildiğinde neonatal ağırlık ile AFP düzeyi arasında negatif yönde, istatistiksel olarak anlamlı bir ilişki bulunmaktadır. Fetal komplikasyon varlığı ile ikinci trimester tarama testi biyokimyasal belirteçlerinden HCG ve E3 kıyaslandığında istatiksel olarak anlamlı bir fark izlenmemiştir. Fetal komplikasyon görülen olguların AFP düzeyleri, fetal komplikasyon görülmeyen olgulardan istatistiksel olarak anlamlı düzeyde yüksek bulunmuştur (p<0.01).
Sonuç: Yüksek AFP MoM değerleri fetal komplikasyon görülmesi açısından uyarıcı olabilirken ikinci trimester tarama testi belirteçlerinin maternal komplikasyonları öngörmede yetersiz olduğu izlenmiştir. Uterin cerrahi geçirilmiş olan ve olmayan gruplarda bu değerlerde fark izlenmemiştir. Bu çalışmanın daha büyük örneklem ile yapılması daha değerli bilgiler elde edilmesini sağlayacaktır.

References

  • Referans1 Sayın N, Canda M, Ahmet N, Arda S, Süt N, Varol F Theassociation of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns. Arch of Gynecol&Obstet. 2008;277(1):47-53
  • Referans2 Dugoff L. First andsecond-trimestermaternal serum markers for aneuploidy and adverse obstetric outcomes. Obstet Gyne¬col.2010;115(5):1052-61
  • Referans3 Gagnon A, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can. 2008;30(10):918–32
  • Referans4 Hu JL, Zhang YJ, Zhang JM et al Pregnancy outcomes of women with elevated second-trimester maternal serum alpha-fetoprotein. Taiwan J Obstet Gynecol. 2020;59(1):73-78
  • Referans5 Başbuğ D, Başbuğ A, Gülerman C Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome? Ginekol Pol. 2017;88(6):325-330
  • Referans6 Morssink LP, Wolf BT, Kornman LH, Beekhuis JR. The relation between serum markers in the second trimester and plasental pathology. Br J Obstet Gynaecol.1996;103(8):779-83
  • Referans7 Hsieh TT, Hung TH, Hsu JJ, et al. Prediction of adverse perinatal outcome by maternal serum screening for Down syndrome in an Asian population. Obstet Gynecol. 1997;89(6):937-40
  • Referans8 Hung TH,Shau WY,Hsieh CC, et. Al.Risk factors for placenta accreta. Obstet Gynecol.1999;93(4):545-50
  • Referenas9 Lyell DJ, Faucett AM, Baer RJ 3, et. al. Maternal serum markers, characteristics and morbidly adherent placenta in women with previa. J Perinatol. 2015;35(8):570-4.
  • Referans10 Oztas E, Ozler S, Caglar AT, Yucel A Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy. Kaohsiung J MedSci. 2016;32(11):579-85.
  • Referans11 Krause TG, Christens P, Wohlfahrt J, Lei U, et al. Second-trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome. Obstet Gyneacol. 2001;97(2):277-82
  • Referans12 Demirkiran O, Dikmen Y, Utku T, Urkmez S. Critically ill obstetric patients in the intensive care unit. Int J Obstet Anesth. 2003;12(4):266-70.
  • Referans13 Ott W: Primary caesarean section; factors related to postpartum infectîon. Obstet Gynecol. 1981;57(2):171–78
  • Referans14 Çiçek N, Akyürek C,Çelik Ç, Haberal A. İkinci Trimester Fetal Anomali Tarama Testleri Ch.35 Kadın Hastalıkları ve Doğum Bilgisi II. Baskı Ankara: Güneş Kitabevi,2006;399-410
  • Referans15 Heinonen S, Ryynanen M, Kirkinen P, Saarikoski S. Elevated mid-trimester maternal serum HCG in chromosomally normal pregnancies is associated with preeklampsia and velamentous umblical cord insertion. Am J Perinatol 1996;13(7): 437-41

The Relationship of Second Trimester Screening Test Biochemical Markers and Poor Pregnancy Outcomes in Patients with A History Of Cesarean

Year 2022, Volume: 14 Issue: 1, 11 - 15, 30.04.2022
https://doi.org/10.35514/mtd.2022.61

Abstract

Objective: The purpose of this study is to investigate the association between maternal serum levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), unconjugatedestriol (uE3) and poor pregnancy outcomes, determine whether these markers are effective predictors of poor pregnancy outcomes and to compare their levels in women with prior cesarean section and no prior uterine surgery.
Materials and Methods: Women with cesarean section due to a previous uterine surgery (n= 87) and women with no prior uterine surgery and performed vaginal delivery (n= 105) whose prenatal care was performed in the same clinic were included. Second trimester maternal serum levels of AFP, HCG and uE3, as well as multiples of the median (MoM) of these markers were evaluated. Differences in biochemical marker levels between groups and their relationship to poor maternal-fetal outcomes were assessed.
Results: AFP, HCG, and uE3 levels of second trimester screening test markers, no statistically significant difference was found between the groups. When both groups are evaluated together, there is a negative, statistically significant association between neonatal weight and AFP level. When comparing the presence of fetal complications and the biochemical markers of the second trimester screening test HCG and E3, no statistically significant difference was observed. It was found that AFP levels of cases with fetal complications were statistically significantly higher than those of cases without fetal complications (p<0.01).
CONCLUSION: While high AFP-MoM levels may be a warning of fetal complications, second trimester screening test markers were found to be insufficient to predict maternal complications. The levels of these markers was not different between women with prior cesarean section or no prior uterine surgery. Conducting this study with a larger sample could provide further valuable information.

References

  • Referans1 Sayın N, Canda M, Ahmet N, Arda S, Süt N, Varol F Theassociation of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns. Arch of Gynecol&Obstet. 2008;277(1):47-53
  • Referans2 Dugoff L. First andsecond-trimestermaternal serum markers for aneuploidy and adverse obstetric outcomes. Obstet Gyne¬col.2010;115(5):1052-61
  • Referans3 Gagnon A, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can. 2008;30(10):918–32
  • Referans4 Hu JL, Zhang YJ, Zhang JM et al Pregnancy outcomes of women with elevated second-trimester maternal serum alpha-fetoprotein. Taiwan J Obstet Gynecol. 2020;59(1):73-78
  • Referans5 Başbuğ D, Başbuğ A, Gülerman C Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome? Ginekol Pol. 2017;88(6):325-330
  • Referans6 Morssink LP, Wolf BT, Kornman LH, Beekhuis JR. The relation between serum markers in the second trimester and plasental pathology. Br J Obstet Gynaecol.1996;103(8):779-83
  • Referans7 Hsieh TT, Hung TH, Hsu JJ, et al. Prediction of adverse perinatal outcome by maternal serum screening for Down syndrome in an Asian population. Obstet Gynecol. 1997;89(6):937-40
  • Referans8 Hung TH,Shau WY,Hsieh CC, et. Al.Risk factors for placenta accreta. Obstet Gynecol.1999;93(4):545-50
  • Referenas9 Lyell DJ, Faucett AM, Baer RJ 3, et. al. Maternal serum markers, characteristics and morbidly adherent placenta in women with previa. J Perinatol. 2015;35(8):570-4.
  • Referans10 Oztas E, Ozler S, Caglar AT, Yucel A Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy. Kaohsiung J MedSci. 2016;32(11):579-85.
  • Referans11 Krause TG, Christens P, Wohlfahrt J, Lei U, et al. Second-trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome. Obstet Gyneacol. 2001;97(2):277-82
  • Referans12 Demirkiran O, Dikmen Y, Utku T, Urkmez S. Critically ill obstetric patients in the intensive care unit. Int J Obstet Anesth. 2003;12(4):266-70.
  • Referans13 Ott W: Primary caesarean section; factors related to postpartum infectîon. Obstet Gynecol. 1981;57(2):171–78
  • Referans14 Çiçek N, Akyürek C,Çelik Ç, Haberal A. İkinci Trimester Fetal Anomali Tarama Testleri Ch.35 Kadın Hastalıkları ve Doğum Bilgisi II. Baskı Ankara: Güneş Kitabevi,2006;399-410
  • Referans15 Heinonen S, Ryynanen M, Kirkinen P, Saarikoski S. Elevated mid-trimester maternal serum HCG in chromosomally normal pregnancies is associated with preeklampsia and velamentous umblical cord insertion. Am J Perinatol 1996;13(7): 437-41
There are 15 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Hacer Kavak Yıldırım 0000-0001-9791-5706

Halenur Bozdağ 0000-0002-2985-0792

Ayşe Deniz Ertürk Coşkun 0000-0003-0658-2366

Zeynep Ece Utkan Korun 0000-0002-1595-569X

Ahmet Göçmen 0000-0002-0839-7490

Publication Date April 30, 2022
Submission Date March 5, 2022
Published in Issue Year 2022 Volume: 14 Issue: 1

Cite

Vancouver Kavak Yıldırım H, Bozdağ H, Ertürk Coşkun AD, Utkan Korun ZE, Göçmen A. Geçirilmiş Sezaryen Öyküsü Olan Hastalarda İkinci Trimester Tarama Testi Biyokimyasal Belirteçlerinin Kötü Gebelik Sonuçlarıyla İlişkisi. Maltepe tıp derg. 2022;14(1):11-5.