ARNOLD-CHİARİ MALFORMASYONU: GEBELİK ÖNCESİ BAKIM ÖNEMİ VE YENİDOĞAN SONUÇLARI

Amaç: Bu çalışmada kliniğimizde yatırılarak tedavi alan Arnold chiari tip 2 malformasyonu tanılı, olguların cinsiyet,doğum şekli, gestasyonel hafta, doğum ağırlığı, eşlik eden ek anomaliler, eğitim durumu, antenatal bakımve folik asit kullanımı, yenidoğan dönemindeki operasyonlar, doğum sonrası yenidoğanda gözlenen problemlerve sekeller gibi postnatal sonuçlar değerlendirilmesi amaçlandı.Gereç ve Yöntem: Karadeniz Teknik Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD’da Ocak 2016ile Mayıs 2018 tarihleri arasında Arnold Chiari Tip 2 tanısıyla kliniğine yatırılan tüm bebekler bu tek merkezliretrospektif çalışmaya alındı. Hastalara ait verilere tıbbi kayıtlardan ulaşıldı.Bulgular: Çalışmaya toplam 20 Arnold chiari tip 2 malformasyonu olan olgu dahil edildi. Akraba evliliği hiçbirolguda yoktu. Gebelerde folik asit kullanımı sadece 2 (%20) olguda mevcuttu. 10(%50) olguda tanı viyabilitesınırından önce konulmuş ve aile gebelik terminasyonu istemişti. Terminasyonu kabul eden 10 olgudan 4 (%40)tanesine meningosel/ meningomyelosel eşlik ediyordu. Gebeliğin devamına karar veren 10 olgudan 6 (%60)tanesine meningosel-meningomyelosel eşlik ediyordu. Olguların medyan gebelik yaşı 37 hafta, ortalama yenidoğanağırlığı 3117±522 gram, medyan 1.dakika ve 5.dakika APGAR skoru sırasıyla 6 ve 8 idi. Yenidoğanların 6‘sı erkek (%60), 4’ü kız (%40) idi. Bebekler ortalama postnatal 3. günde opere edildi. %90’nına şant operasyonuuygulandı. 9 olguda fizik tedavi uygulaması gerektiren hareket kısıtlılığı ve güç kaybı mevcuttu. 7(%70) olgudabir ekstremitede hareket kısıtlığı ve güç kaybı var iken, 2 (%20) olguda her iki alt ekstremitede hareket ve kasgücü izlenmedi. Beş (%50) yenioğanda miksiyon ve defekasyon sorunu nedeni ile temiz aralıklı katater uygulamasıgereksinimi oluşmuştu.Sonuç: Yapılan çalışmalardan ve kliniğimizdeki olgulardan da anlaşılacağı gibi NTD olgularında folik asit kullanmamayada düzensiz kullanım öyküleri mevcut. Bu sebepten kliniğimizde değerlendirilen olgulara yüksekoranda NTD eşlik etmekte.

Arnold-Chiari Malformation: The significance of Pre-pregnancy Care and Newborn Outcomes

Background: The aim of this study evaluate to properties of patients such as gender, birth type, gestational week, birth weight, accompanied additional anomalies, education status, antenatal care and folic acid usage, neonatal operations, postnatal outcomes. Material and Methods: All infants were taken to this single center retrospective study who admitted to the clinic with the diagnosis of Arnold Chiari Type 2 between January 2016 and May 2018 in Karadeniz Technical University, Faculty of Medicine, Department of Obstetrics and Gynecology. Results: A total of 20 Arnold chiari type 2 malformation cases were included in the study. There was no consanguineous marriage. The use of folic acid in pregnancies was only 2 (20%). In 10 (50%) cases the diagnosis was made before the limit of viability and the family asked for pregnancy termination. Meningocele / meningomyelocele were associated with 4 (40%) of 10 cases who accepted the termination. Meningocelemeningomyelocele was associated with 6 (60%) of 10 cases who decided to continue their pregnancy. The median gestational age of the cases was 37 weeks, mean newborn weight was 3117 ± 522 grams, median 1st minute and 5th minute APGAR score was 6 and 8, respectively. 6 of the newborns were male (60%) and 4 were girls (40%). Babies were operated on average postnatal 3. day. Shunt operation was applied to 90%. In 9 cases, there was limitation of movement and loss of power which necessitated physical therapy. 7 (70%) had limb movement limitation and power loss while 2 (20%) had no movement and muscle strength in both lower limbs. Five (50%) newborns required the application of intermittent clean catheters with the reason of mass and defecation problem. Conclusion: There was an irregular use history and not using of folic acid in NTD cases as it is understood from the studies done and the events in our clinic. In this respect, the cases evaluated in our clinic are accompanied by NTD at a high level.

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