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Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar ve Ebelik Yaklaşımı

Yıl 2020, Cilt: 2 Sayı: 1, 30 - 36, 29.02.2020

Saadet Yazıcı Emine Kınık

Öz

Sistemik otoimmün hastalıklar üreme çağındaki kadınlarda yaygın olarak görülmektedir. Otoimmün hastalıklar vücudun kendi hücrelerine karşı anormal immünolojik reaksiyon ile karakterize, doku ve organlarda iltihaplanma ve hasar ile sonuçlanan hastalıklardır. Gebelikte annenin immün sistemi, fetüsün immün sistemine uyum cevabı verecek şekilde değişir. Gebelik nedeni ile bazı otoimmün hastalıklar (SLE, RA vb.) agreve olurken bazıları ise hiçbir alevlenici ya da ilerleyici etki göstermemektedir. Ancak otoimmün hastalıkların tedavisi gebelik sürecinde istenmeyen etkilere neden olabilmektedir. Otoimmün hastalığa sahip kadınlarda, hastalık sebebi ile meydana gelebilecek fizyolojik değişimler ve komplikasyonlar açısından hastalığın uygun değerlendirilmesi ve yönetimi kritik öneme sahiptir. Bu nedenle sağlık bakım profesyonelleri otoimmün hastalıkların gebelikte yönetimi ve gebeliğe olan etkileri hakkında bilgi sahibi olmalıdır.
Anahtar kelimeler: Ebelik Yaklaşımı; gebelik, otoimmün hastalık

Anahtar Kelimeler

ebelik yaklaşımı gebelik

Kaynakça

  • Kavanaugh A, Cush JJ, Ahmed MS, Bermas BL, Chakravarty E, Chambers C, and et al. Proceedings From the American Collage of Rheumatology Reproductive Health Summit: The Management of Fertility, Pregnancy and Lactation in Women with Autoimmune and Systemic Inflamatory Diseases. Arthritis Care & Research, 2015;67(3), 313-325.
  • Chen JS, Roberts CL, Simpson JM, March LM. Pregnancy Outcomes in Women with Rare Autoimmune Diseases. Arthritis & Rheumatology, 2015;6(12), 3314-3323.
  • Tsao NW, Sayre EC, Hanley G, Sadatsafavi M, Lynd LD, Marra CA, and et al. Risk of Preterm Delivery and Small-for Gestasional Age Births in Women with Autoimmune Disease Using Biologics Before or During Pregnancy: A Population Based Cohort Study. Ann Rheum Dis, 2018;0, 1-6.
  • King TL, Brucker MC, Osborne K, Jevitt CM, eds. Varney’s Midwifery. USA: Jones & Barlett Learning; 2019.
  • Bhide A, Arulkumaran S, Damania KR, Daftary SN, eds. Aria’s Practical Guide to High Risk Pregnancy & Delivery. India: Elsevier; 2015.
  • Naseri EP, Surita FG, Borovac-Pinheiro A, Santos M, Appenzeller S, Costallat LT. Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies. Rev Bras Ginecol Obstet, 2018;40, 587-597.
  • Yamamoto Y, Aoki S. Systemic Lupus Eryhtematosus: Strategies to İmprove Pregnancy Outcomes. International Journal of Women’s Health, 2016;8, 265-272.
  • Megan EB, Clowse MD. Lupus Activity in Pregnancy. Rheum Dis Clin North Am, 2007; 33(2), 237.
  • Khan A, Thomas M, Devi S. Pregnancy Complicated by Systemic Lupus Erythematosus and It’s Outcome Over 10 Years. Journal of Obstetric and Gynaecology, 2018; 38(4), 476-481.
  • Chen D, Lao M, Zhang J, Zhan Y, Li W, Cai X, and et al. Fetal and Maternal Outcomes of Planned Pregnancy in Patients with Systemic Lupus Erythematosus: A Retrospective Multicenter Study. Journal of Immunology Research, 2018.
  • Doria A, Ghirardello A, Laccarino L, Zampieri S, Punzi L, Tarricone E, and et al. Pregnancy Cytokines, and Disease Activity in Systemic Lupus Erythematosus. Arthritis & Rheumatism, 2004;51(6), 989-995.
  • Ostensen M, Förger F. How Safe are Anti-Rheumatic Drugs During Pregnancy? Current Opinion in Pharmacology, 2013;13(3), 470-475.
  • Zhao C, Zhao J, Huang Y, et al: New-onset systemic lupus erythematosus during pregnancy. Clin Rheumatol, 2013;32(6), 815.
  • Derksen RH, Bruinse HW, de Groot PG, Kater L. Pregnancy in systemic lupus erythematosus: a prospective study. Lupus 1994; 3(3), 149-155.
  • Ambrosio P, Lermann R, Cordeioro A, Borges A, Nogueira I, Serrano F. Lupus and Pregnancy- 15 years of experience in tertiory center. Clin Rev Allergy Immunol, 2010;38(2-3), 77-81.
  • Norwitz ER, Zelop CM, Miller DA, Keefe DL, eds. Evidence-Based Obstetrics and Gynecology. UK: John Wiley & Sons Ltd; 2019.
  • Viall CA, Chamley LW. Histopathology in the Placenta of Women with Antiphospholipid Antibodies: A Systematic Review of the Literature. Autoimmunity Reviews, 2015;14(5), 446-471.
  • Chighizola CB, Shoenfeld Y, Meroni PL. Therapy for Antiphospolipid Miscarriages: Throwing the Baby out with the Bathwater? American Journal of Reproductive Immunology, 2017;79(3).
  • Cervera R, Serrano R, Pons-Estel GJ, Hualde J, Shoenfeld Y, de Ramon E, and et al. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis, 2015;74(6), 1011-1018.
  • Erkan D, Aguiar CL, Andrade D, Cohen H, Cuadrado MJ, Danowski A, and et al. 14th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends. Autoimmunity Reviews, 2014; 13(6), 685-696.
  • Sciascia S, Hunt BJ, Garcia ET, Lliso G, Khamashata MA, Cuadrado MJ. The impact of hydroxychloroquine treatment on pregnancy outcome in women with antiphospholipid antibodies. American Journal of Obstetrics and Gynaecology, 2016;214(2), 273.
  • Schreiber K, Hunt BJ. Pregnancy and Antiphospholipid Syndrome. Semin Thromb Hemost 2016; 42(07), 780-788.
  • Queenan JT, Spong CY, Lockwood CJ. Protocols for High-Risk Pregnancies. West Sussex: Wiley Blackwell; 2015.
  • Barrett JH, Brennan P, Fiddler M, Silman AJ. Does rheumatoid arthritis remit during pregnancy and relapse postpartum? Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy. Arthritis & Rheumatology, 1999; 42(6), 1219-1227.
  • De Man YA, Dolhain RJ, Fleur E, Geijn, VD, Willemsen SP,Hazes JM. Disease Activity of Rheumatoid Arthritis DuringPregnancy: Results From a NationwideProspective Study. Arthritis & Rheumatism, 2008;59(9), 1241-1248.
  • Mitchell K, Kaul M, Clowse ME. The management of rheumatic diseases in pregnancy. Scand J Rheumatol, 2010;39(2), 99-108.
  • Collins S, Aralkumaran S, Hayes K, Jackson S, Impey L. Oxford Handbook of Obstetrics and Gynaecology. UK: Oxford University Press: 2013.
  • Chambers CD, Johnson DL, Robinson LK, Braddock SR, Xu R, Jimenez JL, and et al. Birth Outcomes in Women Who Have Taken Leflunomide During Pregnancy. Arthritis Rheum, 2010;62(5), 1494-1503.
  • Ehrenstein MR, Evans JG, Singh A, Moore S, Warnes G, Isenberg DA, and et al. Compromised Function of Regulatory T Cells in Rheumatoid Arthritis and Reversal by Anti-TNFα Therapy. Journal of Experimental Medicine, 2004;200(3), 277-285.
  • Vignali DA, Collison LW, Workman CJ. How regulatory T cells work. Nature Reviews Immunology, 2008;8, 523-532.
  • Förger F, Marcoli N, Gadola S, Möller B, Villiger PM, Ostensen M. Pregnancy induces numerical and functional changes of CD4+CD25ʰ regulatory T cells in patients with rheumatoid arthritis. Ann Rheum Dis, 2008;67, 984-990.
  • Lazarus JH, Hall R, Othman S, Parkes AB, Richards CJ, McCulloch B, and et al. The clinical spectrum of postpartum thyroid disease. An International Journal of Medicine, 1996;89(6), 429-436.
  • Unuane D, Velkeniers B, Anckaert E, Schiettecatte J, Tournaye H, Haentjents P, and et al. Thyroglobulin Autoantibodies: Is There Any Added Value in the Detection of Thyroid Autoimmunity in Women Consulting for Fertility Treatment? Thyroid. 2013;23(8).
  • Korevaar TI, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy:new insights in diagnosis and clinical management. Nature Reviews/ Endocrinology, 2017;13, 610-622.
  • Van den Boogard E, Vissenberg R, Land JA, Van Wely M, Van der Post JA, Goddjin M, and et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Human Reproduction Update, 2011;17(5), 615-619.
  • Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine Treatment in Euthyroid Pregnant Women with Autoimmune Thyroid Disease: Effects on Obstetrical Complications. The Journal of Clinical Endocrinology & Metabolism, 2006;91(7), 2587–2591.
  • Nazarpour S, Tehrani FR, Simbar M, Azizi F. Thyroid dysfunction and pregnancy outcomes. Iran J Reprod Med, 2015;13(7), 387-396.
  • ISRCTNregistry Thyroid AntiBodies and LEvoThyroxine study (TABLET) trial registration. ISRCTNregistry http://www.isrctn.com/ISRCTN15948785, 2017.
  • Korevaar TI, Steegers EA, Pop VJ, Broeren MA, Chaker L, de Rijke YB, and et al. Thyroid Autoimmunity Impairs the Thyroidal Response to Human Chorionic Gonadotropin: Two Population- Based Prospective Cohort Studies. J Clin Endocrinol Metab, 2017;102(1), 69-77.
  • Ostensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, and et al. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Research & Therapy, 2006;8(3), 209.
  • Leroux M, Desveaux C, Parcevaux M, Julliac B, Gouyon JB, Dallay D, and et al. Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study. Lupus, 2015;24(13), 1384-1391.
  • Levy RA, Vilela VS, Cataldo MJ, Ramos RC, Duarte JL, Tura BR and et al. Hydroxychloroquine (HCQ) in lupus pregnancy: double-blind and placebo-controlled study. Lupus, 2001;10(6), 401-404.
  • Akıncı AÇ, Çetin FC. Gebelikte Romatoid Artrit ve Yönetimi. HSP, 2017;4(3), 244-251.
  • Briggs GG, Freeman RK, eds. Drugs in Pregnancy and Lactation. China: Wolters Kluwer; 2015.
  • Cnossen JS, Morris RK, ter Riet G, Mol BW, van der Post JA, Coomarasamy A, and et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ, 2008;178(6), 701-711.
  • Ostensen M, Çetin I. Autoimmune connective tissue diseases. Best Practice & Research Clinical Obstetrics & Gynaecology, 2015;29(5), 658-670.
  • Aydemir H, Hazar HU. Düşük Riskli, Riskli, Yüksek Riskli Gebelik ve Ebenin Rolü. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2014;3(2).
  • Özkaraman A, Özer S, Alparslan GB. Romatoid artritli bir vakanın hemşirelik bakımında Roy adaptasyon modelinin kullanımı. Gümüşhane Üni, Sağ Bil Derg, 2012;1(3).
  • Nugent, PM, Green, JS, Pelikan, PK, Saul MH, eds. Mosby’s Comprehensive Review of Nursing fort he NCLEX-RN EXAMİNATİON. St. Louis, Missouri; Elsevier/Mosby, 2012.

Common Autoimmun Disease During Pregnancy and Midwifery Approach

Yıl 2020, Cilt: 2 Sayı: 1, 30 - 36, 29.02.2020

Saadet Yazıcı Emine Kınık

Öz

Systemic autoimmune diseases are relatively common in women of childbearing age. Autoimmune diseases are characterized by an abnormal immunologic reaction against one’s own cells, tissues, and organs, resulting in inflammation and damage. During pregnancy, the immune system changes in response to accommodation of the fetal immune system. Because of pregnancy, some autoimmune disorders (e.g., rheumatoid arthritis, systematic lupus erythematosus) improve during pregnancy. For others, pregnancy has no effect on the progress of the disorder but the disorder or treatment can have adverse effects on the course of pregnancy. The awareness of pregnancy-related physiologic changes and complications is critical for the appropriate assessment and management of pregnant patients with systemic autoimmune diseases. Therefore, health care professionals should be informed about the management of autoimmune diseases during pregnancy and their effects on pregnancy

Anahtar Kelimeler

Midwifery approach; pregnancy; autoimmun disease

Kaynakça

  • Kavanaugh A, Cush JJ, Ahmed MS, Bermas BL, Chakravarty E, Chambers C, and et al. Proceedings From the American Collage of Rheumatology Reproductive Health Summit: The Management of Fertility, Pregnancy and Lactation in Women with Autoimmune and Systemic Inflamatory Diseases. Arthritis Care & Research, 2015;67(3), 313-325.
  • Chen JS, Roberts CL, Simpson JM, March LM. Pregnancy Outcomes in Women with Rare Autoimmune Diseases. Arthritis & Rheumatology, 2015;6(12), 3314-3323.
  • Tsao NW, Sayre EC, Hanley G, Sadatsafavi M, Lynd LD, Marra CA, and et al. Risk of Preterm Delivery and Small-for Gestasional Age Births in Women with Autoimmune Disease Using Biologics Before or During Pregnancy: A Population Based Cohort Study. Ann Rheum Dis, 2018;0, 1-6.
  • King TL, Brucker MC, Osborne K, Jevitt CM, eds. Varney’s Midwifery. USA: Jones & Barlett Learning; 2019.
  • Bhide A, Arulkumaran S, Damania KR, Daftary SN, eds. Aria’s Practical Guide to High Risk Pregnancy & Delivery. India: Elsevier; 2015.
  • Naseri EP, Surita FG, Borovac-Pinheiro A, Santos M, Appenzeller S, Costallat LT. Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies. Rev Bras Ginecol Obstet, 2018;40, 587-597.
  • Yamamoto Y, Aoki S. Systemic Lupus Eryhtematosus: Strategies to İmprove Pregnancy Outcomes. International Journal of Women’s Health, 2016;8, 265-272.
  • Megan EB, Clowse MD. Lupus Activity in Pregnancy. Rheum Dis Clin North Am, 2007; 33(2), 237.
  • Khan A, Thomas M, Devi S. Pregnancy Complicated by Systemic Lupus Erythematosus and It’s Outcome Over 10 Years. Journal of Obstetric and Gynaecology, 2018; 38(4), 476-481.
  • Chen D, Lao M, Zhang J, Zhan Y, Li W, Cai X, and et al. Fetal and Maternal Outcomes of Planned Pregnancy in Patients with Systemic Lupus Erythematosus: A Retrospective Multicenter Study. Journal of Immunology Research, 2018.
  • Doria A, Ghirardello A, Laccarino L, Zampieri S, Punzi L, Tarricone E, and et al. Pregnancy Cytokines, and Disease Activity in Systemic Lupus Erythematosus. Arthritis & Rheumatism, 2004;51(6), 989-995.
  • Ostensen M, Förger F. How Safe are Anti-Rheumatic Drugs During Pregnancy? Current Opinion in Pharmacology, 2013;13(3), 470-475.
  • Zhao C, Zhao J, Huang Y, et al: New-onset systemic lupus erythematosus during pregnancy. Clin Rheumatol, 2013;32(6), 815.
  • Derksen RH, Bruinse HW, de Groot PG, Kater L. Pregnancy in systemic lupus erythematosus: a prospective study. Lupus 1994; 3(3), 149-155.
  • Ambrosio P, Lermann R, Cordeioro A, Borges A, Nogueira I, Serrano F. Lupus and Pregnancy- 15 years of experience in tertiory center. Clin Rev Allergy Immunol, 2010;38(2-3), 77-81.
  • Norwitz ER, Zelop CM, Miller DA, Keefe DL, eds. Evidence-Based Obstetrics and Gynecology. UK: John Wiley & Sons Ltd; 2019.
  • Viall CA, Chamley LW. Histopathology in the Placenta of Women with Antiphospholipid Antibodies: A Systematic Review of the Literature. Autoimmunity Reviews, 2015;14(5), 446-471.
  • Chighizola CB, Shoenfeld Y, Meroni PL. Therapy for Antiphospolipid Miscarriages: Throwing the Baby out with the Bathwater? American Journal of Reproductive Immunology, 2017;79(3).
  • Cervera R, Serrano R, Pons-Estel GJ, Hualde J, Shoenfeld Y, de Ramon E, and et al. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis, 2015;74(6), 1011-1018.
  • Erkan D, Aguiar CL, Andrade D, Cohen H, Cuadrado MJ, Danowski A, and et al. 14th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends. Autoimmunity Reviews, 2014; 13(6), 685-696.
  • Sciascia S, Hunt BJ, Garcia ET, Lliso G, Khamashata MA, Cuadrado MJ. The impact of hydroxychloroquine treatment on pregnancy outcome in women with antiphospholipid antibodies. American Journal of Obstetrics and Gynaecology, 2016;214(2), 273.
  • Schreiber K, Hunt BJ. Pregnancy and Antiphospholipid Syndrome. Semin Thromb Hemost 2016; 42(07), 780-788.
  • Queenan JT, Spong CY, Lockwood CJ. Protocols for High-Risk Pregnancies. West Sussex: Wiley Blackwell; 2015.
  • Barrett JH, Brennan P, Fiddler M, Silman AJ. Does rheumatoid arthritis remit during pregnancy and relapse postpartum? Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy. Arthritis & Rheumatology, 1999; 42(6), 1219-1227.
  • De Man YA, Dolhain RJ, Fleur E, Geijn, VD, Willemsen SP,Hazes JM. Disease Activity of Rheumatoid Arthritis DuringPregnancy: Results From a NationwideProspective Study. Arthritis & Rheumatism, 2008;59(9), 1241-1248.
  • Mitchell K, Kaul M, Clowse ME. The management of rheumatic diseases in pregnancy. Scand J Rheumatol, 2010;39(2), 99-108.
  • Collins S, Aralkumaran S, Hayes K, Jackson S, Impey L. Oxford Handbook of Obstetrics and Gynaecology. UK: Oxford University Press: 2013.
  • Chambers CD, Johnson DL, Robinson LK, Braddock SR, Xu R, Jimenez JL, and et al. Birth Outcomes in Women Who Have Taken Leflunomide During Pregnancy. Arthritis Rheum, 2010;62(5), 1494-1503.
  • Ehrenstein MR, Evans JG, Singh A, Moore S, Warnes G, Isenberg DA, and et al. Compromised Function of Regulatory T Cells in Rheumatoid Arthritis and Reversal by Anti-TNFα Therapy. Journal of Experimental Medicine, 2004;200(3), 277-285.
  • Vignali DA, Collison LW, Workman CJ. How regulatory T cells work. Nature Reviews Immunology, 2008;8, 523-532.
  • Förger F, Marcoli N, Gadola S, Möller B, Villiger PM, Ostensen M. Pregnancy induces numerical and functional changes of CD4+CD25ʰ regulatory T cells in patients with rheumatoid arthritis. Ann Rheum Dis, 2008;67, 984-990.
  • Lazarus JH, Hall R, Othman S, Parkes AB, Richards CJ, McCulloch B, and et al. The clinical spectrum of postpartum thyroid disease. An International Journal of Medicine, 1996;89(6), 429-436.
  • Unuane D, Velkeniers B, Anckaert E, Schiettecatte J, Tournaye H, Haentjents P, and et al. Thyroglobulin Autoantibodies: Is There Any Added Value in the Detection of Thyroid Autoimmunity in Women Consulting for Fertility Treatment? Thyroid. 2013;23(8).
  • Korevaar TI, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy:new insights in diagnosis and clinical management. Nature Reviews/ Endocrinology, 2017;13, 610-622.
  • Van den Boogard E, Vissenberg R, Land JA, Van Wely M, Van der Post JA, Goddjin M, and et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Human Reproduction Update, 2011;17(5), 615-619.
  • Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine Treatment in Euthyroid Pregnant Women with Autoimmune Thyroid Disease: Effects on Obstetrical Complications. The Journal of Clinical Endocrinology & Metabolism, 2006;91(7), 2587–2591.
  • Nazarpour S, Tehrani FR, Simbar M, Azizi F. Thyroid dysfunction and pregnancy outcomes. Iran J Reprod Med, 2015;13(7), 387-396.
  • ISRCTNregistry Thyroid AntiBodies and LEvoThyroxine study (TABLET) trial registration. ISRCTNregistry http://www.isrctn.com/ISRCTN15948785, 2017.
  • Korevaar TI, Steegers EA, Pop VJ, Broeren MA, Chaker L, de Rijke YB, and et al. Thyroid Autoimmunity Impairs the Thyroidal Response to Human Chorionic Gonadotropin: Two Population- Based Prospective Cohort Studies. J Clin Endocrinol Metab, 2017;102(1), 69-77.
  • Ostensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, and et al. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Research & Therapy, 2006;8(3), 209.
  • Leroux M, Desveaux C, Parcevaux M, Julliac B, Gouyon JB, Dallay D, and et al. Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study. Lupus, 2015;24(13), 1384-1391.
  • Levy RA, Vilela VS, Cataldo MJ, Ramos RC, Duarte JL, Tura BR and et al. Hydroxychloroquine (HCQ) in lupus pregnancy: double-blind and placebo-controlled study. Lupus, 2001;10(6), 401-404.
  • Akıncı AÇ, Çetin FC. Gebelikte Romatoid Artrit ve Yönetimi. HSP, 2017;4(3), 244-251.
  • Briggs GG, Freeman RK, eds. Drugs in Pregnancy and Lactation. China: Wolters Kluwer; 2015.
  • Cnossen JS, Morris RK, ter Riet G, Mol BW, van der Post JA, Coomarasamy A, and et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ, 2008;178(6), 701-711.
  • Ostensen M, Çetin I. Autoimmune connective tissue diseases. Best Practice & Research Clinical Obstetrics & Gynaecology, 2015;29(5), 658-670.
  • Aydemir H, Hazar HU. Düşük Riskli, Riskli, Yüksek Riskli Gebelik ve Ebenin Rolü. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2014;3(2).
  • Özkaraman A, Özer S, Alparslan GB. Romatoid artritli bir vakanın hemşirelik bakımında Roy adaptasyon modelinin kullanımı. Gümüşhane Üni, Sağ Bil Derg, 2012;1(3).
  • Nugent, PM, Green, JS, Pelikan, PK, Saul MH, eds. Mosby’s Comprehensive Review of Nursing fort he NCLEX-RN EXAMİNATİON. St. Louis, Missouri; Elsevier/Mosby, 2012.
Toplam 49 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derleme
Yazarlar

Saadet Yazıcı

Emine Kınık 0000-0002-5701-4046

Yayımlanma Tarihi 29 Şubat 2020
Gönderilme Tarihi 29 Kasım 2019
Yayımlandığı Sayı Yıl 2020 Cilt: 2 Sayı: 1

Kaynak Göster

APA Yazıcı, S., & Kınık, E. (2020). Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar ve Ebelik Yaklaşımı. Sağlık Profesyonelleri Araştırma Dergisi, 2(1), 30-36.
AMA Yazıcı S, Kınık E. Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar ve Ebelik Yaklaşımı. Sağlık Pro Arş Dergisi. Şubat 2020;2(1):30-36.
Chicago Yazıcı, Saadet, ve Emine Kınık. “Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar Ve Ebelik Yaklaşımı”. Sağlık Profesyonelleri Araştırma Dergisi 2, sy. 1 (Şubat 2020): 30-36.
EndNote Yazıcı S, Kınık E (01 Şubat 2020) Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar ve Ebelik Yaklaşımı. Sağlık Profesyonelleri Araştırma Dergisi 2 1 30–36.
IEEE S. Yazıcı ve E. Kınık, “Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar ve Ebelik Yaklaşımı”, Sağlık Pro Arş Dergisi, c. 2, sy. 1, ss. 30–36, 2020.
ISNAD Yazıcı, Saadet - Kınık, Emine. “Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar Ve Ebelik Yaklaşımı”. Sağlık Profesyonelleri Araştırma Dergisi 2/1 (Şubat 2020), 30-36.
JAMA Yazıcı S, Kınık E. Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar ve Ebelik Yaklaşımı. Sağlık Pro Arş Dergisi. 2020;2:30–36.
MLA Yazıcı, Saadet ve Emine Kınık. “Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar Ve Ebelik Yaklaşımı”. Sağlık Profesyonelleri Araştırma Dergisi, c. 2, sy. 1, 2020, ss. 30-36.
Vancouver Yazıcı S, Kınık E. Gebelikte Sık Karşılaşılan Otoimmün Hastalıklar ve Ebelik Yaklaşımı. Sağlık Pro Arş Dergisi. 2020;2(1):30-6.
 Kapak Resmi İndir

SAĞLIK PROFESYONELLERİ ARAŞTIRMA DERGİSİ / JOURNAL OF HEALTH PROFESSIONALS RESEARCH /J HEALTH PRO RES