Hidroksiprogesteron kaproat enjeksiyonu, ikinci trimester tarama belirteçlerini ve yenidoğan sonuçlarını değiştirir mi?
Öz
Amaç: İkinci trimesterde, alfa-fetoprotein (AFP), konjuge olmayan estriol (uE3) ve insan koryonik gonadotropin (hCG) gibi maternal serum markırlarını biyokimyasal olarak değerlendirerek; nöral tüp defekti (NTD) ve bazı fetal anöploidi taraması yapılabilmektedir. İkinci trimesterde düşük tedavisi için 17-hidroksiprogesteron kaproat (17OHPC) takviyesinin bu markerleri etkileyip etkilemediğini değerlendirmek. Ayrıca, gebelerde 17OHPC kullanımının gebelik sonuçlarına etkisini değerlendirmektir.
Yöntemler: Bu retrospektif çalışma Aralık 2014 ile Mart 2018 arasında 1275 gebe içermekteydi. Annelik yaşı, tarama sırasındaki vücut kitle indeksi (VKİ), tarama sırasındaki gebelik yaşı, maternal serum AFP, uE3 ve hCG düzeyleri, fetal cinsiyet, fetal doğum ağırlığı, Apgar skoru 5. dakika <7 ve yenidoğan yoğun bakım ünitesine (NICU) giriş değerlendirildi.
Bulgular: Anne yaşı, VKİ, gebelik yaşı, fetal cinsiyet, fetal doğum ağırlığı, Apgar skoru 5. dakika <7 ve NICU'ya kabul edilmesinde istatistiksel olarak anlamlı bir fark yoktu. Ortalama maternal serum uE3 ve AFP düzeyleri progesteron grubunda kontrol grubuna göre anlamlı derecede düşüktü (sırasıyla p=0,008, p=0,046). Bununla birlikte, ortalama maternal serum hCG düzeyleri progesteron grubunda kontrol grubundan anlamlı derecede yüksekti (p=0,033).
Sonuçlar: Fetal anöploidi ve NTD'ler için yapılan ikinci trimester tarama testleri, 17OHPC kullanan hamile kadınlarda yanlış sonuçlar verebilir. Bu yanlış sonuçlar yanlış tanı ve aşırı yönetime neden olabilir. 17OHPC kullanan gebelerde bu belirteçler için yeni eşik değerleri tanımlanmalıdır.
Anahtar Kelimeler
17-hidroksiprogesteron-kaproat Doğum öncesi tarama testleri Progesteron tedavisi Erken doğum
Kaynakça
- 1. Luo G, Abrahams VM, Tadesse S, Funai EF, Hodgson EJ, Gao J, et al. Progesterone inhibits basal and tnf-α-induced apoptosis in fetal membranes: a novel mechanism to explain progesterone-mediated prevention of preterm birth. Reprod Sci. 2010;17(6):532-9.
- 2. Kumar D, Moore, RM, Mercer BM, Mansour JM, Redline, R. The physiology of fetal membrane weakening and rupture: Insights gained from the determination of physical properties revisited. Placenta. 2016;42:59-73.
- 3. Norwitz ER, Lye AJ. Biology of parturition. In: Creasy K.R., ed. Resnick’s Maternal-Fetal Medicine. 6th edition. Philadelphia: Saunders Elseiver, 2008;6:69-85.
- 4. Norwitz ER,Caughey, AB. Progesterone supplementation and the prevention of preterm birth. Rev Obstet Gynecol. 2011;4(2):60.
- 5. Society for Maternal-Fetal Medicine (SMFM) Publications Committee. The choice of progestogen for the prevention of preterm birth in women with singleton pregnancy and prior preterm birth. Am J Obstet Gynecol. 2017;216:B11.
- 6. Manuck TA. 17-alpha hydroxyprogesterone caproate for preterm birth prevention: Where have we been, how did we get here, and where are we going? Semin Perinatol. 2017;41(8):461-7.
- 7. Driscoll DA, Gross SJ, Professional Practice Guidelines Committee. Screening for fetal aneuploidy and neural tube defects. Genet Med. 2009;11:818.
- 8. Alldred SK, Deeks JJ, Guo B, Neilson JP, Alfirevic Z. Second trimester serum tests for Down's Syndrome screening. Cochrane Database Syst Rev. 2012 Jun 13;(6):CD009925.
- 9. Bartkute K, Balsyte D, Wisser J, Kurmanavicius J. Pregnancy outcomes regarding maternal serum AFP value in second trimester screening. J Perinat Med. 2016;45(7):817-20.
- 10. Jou HJ, Shyu MK, Shih JC, Chang MY, Lim CC, Tzeng CY, et al. Second trimester maternal serum hCG level in an Asian population: normal reference values by ultrasound dating. J Matern Fetal Med. 2000;9(2):118-21.
- 11. Turgal M, Aydin E, Ozyuncu O. Effect of micronized progesterone on fetal placental volume in first trimester threatened abortion. J Clin Ultrasound. 2017;45(1):14-9.
- 12. Wehmann RE, Nisula BC. Renal clearance rates of the subunits of human chorionic gonadotropin in man. J Clin Endocrinol Metab. 1980;50(4):674-9.
- 13. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 187: Neural Tube Defects. Obstet Gynecol. 2017;130:e279.
- 14. Klopper A, Varela‐Torres R, Jandial V. Placental metabolism of dehydroepiandrosterone sulphate in normal pregnancy. Br J Obstet Gynaecol. 1976;83(6):478-83.
- 15. Klebanoff MA, Meis PJ, Dombrowski MP, Zhao Y, Moawad AH, Northen A, et al. Salivary progesterone and estriol among pregnant women treated with 17-α-hydroxyprogesterone caproate or placebo. Am J Obstet Gynecol. 2008;199(5):506-e1.
Does hydroxyprogesterone caproate injection alter second trimester screening markers and neonatal outcomes?
Öz
Aim: In the second trimester, biochemically evaluating maternal serum markers such as alpha-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG) may be performed as prenatal screening for neural tube defects (NTDs) and fetal aneuploidy and anomalies. We evaluated whether supplementation of 17-hydroxyprogesteronecaproate (17OHPC) in the second trimester can effect these markers. In addition, we evaluated pregnancy outcomes in pregnant women using 17OHPC.
Methods: This case control study included 1275 pregnant women between December 2014 and March 2018. The progesterone (study) group included women with a previous preterm birth and cervical length >25 mm. The control group included healthy pregnant women with a cervical length >25 mm and no previous preterm birth. Maternal age, body mass index (BMI) at the time of screening, gestational age at the time of screening, levels of maternal serum AFP, uE3, and hCG, fetal sex, fetal birth weight, Apgar score 5th minute <7, and admission to the neonatal intensive care unit (NICU) were evaluated.
Results: There was no statistically significant difference for maternal age, BMI, gestational age, fetal sex, fetal birth weight, Apgar score 5th minute <7, and admission to the NICU. The mean maternal serum uE3 and AFP levels were significantly less in the study group than in control group (P=0.008 and P=0.046, respectively). However, the mean maternal serum hCG levels were significantly higher in the study (P=0.033).
Conclusions: Second trimester screening tests for fetal aneuploidy and NTDs can give incorrect results in pregnant women using 17OHPC. These incorrect results may cause misdiagnosis and over-management. New threshold values for these markers in pregnant women using 17OHPC should be identified.
Anahtar Kelimeler
17-hydroxyprogesterone caproate Prenatal screening tests Progesterone therapy Preterm delivery
Kaynakça
- 1. Luo G, Abrahams VM, Tadesse S, Funai EF, Hodgson EJ, Gao J, et al. Progesterone inhibits basal and tnf-α-induced apoptosis in fetal membranes: a novel mechanism to explain progesterone-mediated prevention of preterm birth. Reprod Sci. 2010;17(6):532-9.
- 2. Kumar D, Moore, RM, Mercer BM, Mansour JM, Redline, R. The physiology of fetal membrane weakening and rupture: Insights gained from the determination of physical properties revisited. Placenta. 2016;42:59-73.
- 3. Norwitz ER, Lye AJ. Biology of parturition. In: Creasy K.R., ed. Resnick’s Maternal-Fetal Medicine. 6th edition. Philadelphia: Saunders Elseiver, 2008;6:69-85.
- 4. Norwitz ER,Caughey, AB. Progesterone supplementation and the prevention of preterm birth. Rev Obstet Gynecol. 2011;4(2):60.
- 5. Society for Maternal-Fetal Medicine (SMFM) Publications Committee. The choice of progestogen for the prevention of preterm birth in women with singleton pregnancy and prior preterm birth. Am J Obstet Gynecol. 2017;216:B11.
- 6. Manuck TA. 17-alpha hydroxyprogesterone caproate for preterm birth prevention: Where have we been, how did we get here, and where are we going? Semin Perinatol. 2017;41(8):461-7.
- 7. Driscoll DA, Gross SJ, Professional Practice Guidelines Committee. Screening for fetal aneuploidy and neural tube defects. Genet Med. 2009;11:818.
- 8. Alldred SK, Deeks JJ, Guo B, Neilson JP, Alfirevic Z. Second trimester serum tests for Down's Syndrome screening. Cochrane Database Syst Rev. 2012 Jun 13;(6):CD009925.
- 9. Bartkute K, Balsyte D, Wisser J, Kurmanavicius J. Pregnancy outcomes regarding maternal serum AFP value in second trimester screening. J Perinat Med. 2016;45(7):817-20.
- 10. Jou HJ, Shyu MK, Shih JC, Chang MY, Lim CC, Tzeng CY, et al. Second trimester maternal serum hCG level in an Asian population: normal reference values by ultrasound dating. J Matern Fetal Med. 2000;9(2):118-21.
- 11. Turgal M, Aydin E, Ozyuncu O. Effect of micronized progesterone on fetal placental volume in first trimester threatened abortion. J Clin Ultrasound. 2017;45(1):14-9.
- 12. Wehmann RE, Nisula BC. Renal clearance rates of the subunits of human chorionic gonadotropin in man. J Clin Endocrinol Metab. 1980;50(4):674-9.
- 13. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 187: Neural Tube Defects. Obstet Gynecol. 2017;130:e279.
- 14. Klopper A, Varela‐Torres R, Jandial V. Placental metabolism of dehydroepiandrosterone sulphate in normal pregnancy. Br J Obstet Gynaecol. 1976;83(6):478-83.
- 15. Klebanoff MA, Meis PJ, Dombrowski MP, Zhao Y, Moawad AH, Northen A, et al. Salivary progesterone and estriol among pregnant women treated with 17-α-hydroxyprogesterone caproate or placebo. Am J Obstet Gynecol. 2008;199(5):506-e1.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 27 Ocak 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 3 Sayı: 1 |
