Seyit Ahmet EROL, Orhan ALTINBOĞA, Atakan TANAÇAN, Ali Turhan ÇAĞLAR, Yaprak ENGİN-ÜSTÜN, A. Seval ÖZGÜ-ERDİNÇ

İNTRAUTERİN FETAL ÖLÜM NEDENİYLE ÖLÜ DOĞUM GERÇEKLEŞTİREN GEBE KADINLARDA ANTENATAL TARAMA TESTİ PARAMETRELERİNİN FETAL ÖLÜM ÜZERİNE OLAN PREDİKTİVİTESİNİN DEĞERLENDİRİLMESİ

AMAÇ: Çalışmamızda intrauterin fetal ölüm nedeniyle ölü doğum gerçekleştirmiş gebe kadınlara ait antenatal tarama testi parametrelerinin retrospektif incelenerek maternal yaş ve doğum haftalarına göre fetal ölüm üzerine olan prediktivitesinin değerlendirilmesi amaçlandı. GEREÇ VE YÖNTEM: Bu retrospektif kohort çalışmaya, 1 Ocak 2017- 15 Haziran 2019 tarihleri arasında Sağlık Bilimleri Üniversitesi, Ankara Dr. Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi’nde 20. gebelik haftası ve üzerinde intrauterin fetal ölüm nedeniyle ölü doğum gerçekleştirmiş olan toplam 394 gebe kadın dahil edildi. Hastalara ait demografik özellikler, doğum karakteristikleri ve antenatal tarama testi (ikili, üçlü test) parametreleri (nukal saydamlık [NT], serbest beta insan koryonik gonadotropin [β-hCG], gebelikle ilişkili plazma protein-A [PAPP-A], hCG, ankonjuge östriol [uE3], serum alfa fetoprotein [ΑFP] ortalamanın katları [MoM] değerleri) 35 yaş altı ve üstü ile 20-34. ve 34 üzeri gebelik haftalarına göre ayrı ayrı gruplar şeklinde karşılaştırıldı. Ayrıca antenatal tarama test parametrelerinin doğum haftası ile korelasyonu değerlendirildi. Verilerin analizi SPSS 26.0 istatistik paket programı kullanılarak yapıldı. BULGULAR: 35 yaş altı ve üstü gruplar arasında, antenatal test parametreleri MoM değerleri, doğum haftası, doğum şekli, doğum ağırlığı yönünden istatistiksel anlamlı fark izlenmedi (p>0.05). 20- 34. ve 34 üzeri gebelik haftalarına göre gruplar arasında, antenatal test parametreleri MoM değerleri yönünden istatistiksel anlamlı fark izlenmedi (p>0.05). Doğum haftası ile ikili test β-hCG, PAPP-A, NT, üçlü test hCG, uE3 ve AFP MoM değerleri arasında istatistiksel anlamlı korelasyon izlenmedi (p>0.05). SONUÇ: İlk trimester NT artışı, serbest β-hCG ve PAPP-A düşüklüğü ile ikinci trimester ΑFP, hCG ve dimerik inhibin alfa artışı tespit edilen olgularda olumsuz gebelik sonuçları yönünden klinisyenler dikkatli olmalıdır.Ancakgünümüzdeölüdoğumunprediktivitesindeklinikpratikte faydası gösterilmiş kesin bir laboratuvar testi henüz bulunmamaktadır. Serum belirteçlerinin tanımlanabilir kombinasyonunun ölü doğum için bir tarama testi kadar iyi performansı şu aşamada gösterilememektedir. Standartlaştırılmış tarama testi parametreleri ve sonuçları ile büyük kohort çalışmalarına ihtiyaç duyulmaktadır.

EVALUATION OF THE PREDICTIVITY OF ANTENATAL SCREENING TEST PARAMETERS IN PREGNANT WOMEN WHO HAD STILLBIRTH DUE TO INTRAUTERINE FETAL DEMISE

AIM: To evaluate the predictivity of antenatal screening test parameters in pregnant women who had stillbirth due to intrauterine fetal demise according to maternal age and gestational birth weeks by retrospectively analysis. MATERIAL AND METHOD: This retrospective cohort study included a total of 394 pregnant women who had a stillbirth due to intrauterine fetal demise at 20 weeks of gestation or later between January 1, 2017, and June 15, 2019. Patients' demographic characteristics, birth characteristics, and antenatal screening test (combined, triple test) parameters (NT, free β-hCG, PAPP-A, hCG, uE3, serum ΑFP MoM values) were compared in separate groups of under and above 35 years of age and 20-34 weeks and above 34 weeks of gestation. Additionally, the correlation of antenatal screening test parameters with gestational week was evaluated. RESULTS: There was no statistically significant difference between groups under and above 35 years of age in terms of antenatal test parameters MoM values, gestational week, mode of delivery, and birth weight (p>0.05). There was no statistically significant difference between the groups of 20-34 weeks and above 34 weeks of gestation in terms of antenatal test parameters MoM values (p>0.05). There was no statistically significant correlation between gestational birth week and the combined test β-hCG, PAPP-A, NT, triple test hCG, uE3 and AFP MoM values (p>0.05). CONCLUSION: Clinicians should be careful about adverse pregnancy outcomes in cases of first-trimester increased NT, low free β-hCG, and PAPP-A, and second-trimester increased AFP, hCG, and dimeric inhibin alpha. However, there is currently no definitive laboratory test that has been demonstrated to be useful for predicting stillbirth in clinical practice. The identifiable combination of serum markers does not perform as well as a screening test for stillbirth at this stage. There is a need for large cohort studies with standardized screening test parameters and results.

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