Seyfettin ULUDAĞ, Ahmet DİRİCAN, Vildan OCAK, Rıza MADAZLI

Gebeliğin 20. haftasında uterin arter Doppleri ve maternal serum alfa-fetoprotein ilişkisi

Bu çalışmada, gebeliğin 20. haftasında yapılan uterin arter Dopplerinin preeklampsi, intrauterin gelişme geriliği ve preterm doğum komplikasyonlarını hangi ölçüde belirleyebildiği incelenerek, "diastolik notch've anormal Doppler bulguları ile maternal serum $alpha$-fetoprotein (MSAFP) üzeyleri arasındaki ilişki incelendi. Fetal anomali, çoğul gebelik ve Tip 1 DM dışında çeşitli risk faktörü taşıyan 80 gebe çalışma grubuna alınarak prospektif olarak izlendi. Gebeliğin 15-18. haftalarında MSAFP düzeyleri ve 20. gebelik haftalarında iki taraflı uterin arter Doppler bulguları elde edildi. Uterin arter Doppler'inde 20. haftada 17 olguda (%21.75) erken diastolik "notch" saptandı. 24. haftada bu olguların 9'unda notch varlığı devam ederken, olguların 8'inde diastolik notch'un kaybolduğu görüldü. Uterin arter Dopplerinde "diastolik notch" varlığının preeklampsi, intrauterin gelişme geriliği ve preterm doğum 'u belirlemede anlamlı bir gösterge olduğu belirlendi. Bu istatistiki anlamlılık preeklampsi için p

The relationship of the uterin artery Doppler at the 20th week of gestation and maternal serum alpha-fetoprotein levels

Background.- In this study, we obtained uterine artery Doppler at 20th week of gestation for prediction of preeclampsia, intrauterine growth retardation (IUGR) and preterm labor. We determined the relationship of early diastolic notch and abnormal uterine artery Doppler with maternal serum $alpha$-fetoprotein (MSAFP) levels for prediction of adverse pregnancy outcome. Design.- In a group of high risk, except fetal anomaly, multiple pregnancy and type 1 DM, 80 pregnant women were followed as a study group prospectively. MSAFP levels at the 15-17th weeks of gestation and bilateral uterine artery Doppler at the 20th week's of gestation were obtained. Results.- Uterine artery early diastolic notch were determined at 20th weeks of gestation in 17 (21,75 %) cases. Early diastolic notch in Doppler was persistent at the 24th weeks in the nine of cases, and in the eight of cases, it was disappeared. In uterine artery Doppler, diastolic notch was found to be a significant predictive factor for preeclampsia IUGR and preterm labor (p

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1. Evans MI, Dvorin E, O'Brien JE, Moody JL, Drugan A. Alpha-Fetoprotein and biochemical screening. In Evans MI (Ed) Reproductive Risks and Prenatal Diagnosis. Appleton & Lange, California, 1992; 223-235. 2. Aristidou A, Van den Hof MC, Campell S, Nicolaides K. Uterin artery Doppler in the investigatiaon of pregnancies with raised maternal serum alpha-fetoprotein. Br J Obstet Gynaecol 1990; 97: 431-435. 3. Konchak PS, Bernstein IM, Capeless EL. Uterine artery Doppler velocimetry in the detection of adverse obstetric outcomes in women with unexplained elevated maternal serum ?-fetoprotein levels. Am J Obstet Gynecol 1995; 173: 1115-1119. 4. Wenstrom KD, Sipes SL, Williamson RA,Grant SS, Trawick DC, Esrle LC. Prediction of pregnancy outcome with single versus serial maternal serum ?-fetoprotein tests. Am J Obstet Gynecol 1992; 167: 1529-1533. 5. Haddad B, Uzan S. Uterine Doppler waveform: prediction and management of pregnancy complications. In Chervenak FA, Kurjak A (eds), The fetus as a Patient. The Parthenon Publishing Group, London 1996; 405-413. 6. Nicolaides KH, Rizzo G, Hecher K. In fetal medicine series ; Plasental ve fetal Doppler.The Parthenon Publishing Group, London 1999; 71-104. Wilkins-Haug L. Unexplained elevated maternal serum a-fetoprotein: What is the appropriate follow-up? Curr Opin Obstet Gynecol 1998; 10: 469-474. 7. Myatt L, Miodovnik M. Prediction of preeclamsia. Semin Perinatol 1999; 23: 45-57. 8. Carrera JM, Mallafre J: Intrauterine growth retardation. In Chervenak FA, Kurjak A (eds). The fetus as a patient; Advances in diagnosis and therapy. The Parthenon Publishing Group, London 1994; 251-287. 9. Waller DK, Lustig LS, Cunningham GC, Feuchtbaum LB, Hook EB. The association between maternal serum alpha-protein and preterm birth, small for gestational age infants, preeclampsia, and placental complications. Obstet Gynecol 1996; 88: 816-822. 10. Sheppard BL, Bonnar J. An ultrastructural study of the uteroplacental spiral arteries in hypertensive and normotensive pregnancy and fetal growth retardation. Br J Obstet Gynaecol 1981; 88: 695-705. 11. Campbell S, Diaz-Recasens J, Griffen D, Cohen-Overbeek TE, Pearse JM, Willson K, Teague MJ. New Doppler technicque for assessing uteroplacental blood flow. Lancet 1983; 675-677. 12. Chung JE, Cho JS, Han SS, Park YW, Kim JW. Uterine artery Doppler velocimetry in the prediction of adeverse obstetric outcomes in explained MSAFP elevations. Yonsei Med J 2000; 41: 17-21. 13. Bower S, Schuchter K, Campbell S. Doppler ultrasound screening as part of routine antenatal scannning: prediction of preeclampsia abd intauterine growth retardation. Br J Obstet Gynaecol 1993; 100: 989-994.