Aslı SOMUNKIRAN, Şennur İLVAN, Zerrin CALAY, Begüm KÖRBEYLİ, Rıza MADAZLI, Yavuz ŞİMŞEK

İntrauterin gelişme geriliği olgularında uterin arter doppler bulgularının plasenta yatak biyopsisi histolojisi ilişkisi

Çalışmanın amacı, intrauterin gelişme geri¬liği olgularında plasenta yatak biyopsisi histo¬lojisinin uterin arter doppler bulgularıyla iliş¬kisini incelemek ve patolojik Doppler bulgularina dayanarak plasentasyondaki bozukluğun önceden belirlenip belirlenemeyeceğini araştır¬maktır. Cerrahpaşa Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı'na başvuran ve ge¬rekli tetkikler sonrası intrauterin gelişme gerili¬ği tanısı koyulan 47 hasta ve fetal gelişimin normal olarak saptandığı 26.kontrol olgusu ça¬lışmaya dahil edildi. Hastalara doğumdan ön¬ceki 3 gün içinde Doppler USG yapıldı. Uterin arter ortalama S/D oranının >2,6 olması ve di-yastolik çentik bulunması anormal olarak ka¬bul edildi. Sezaryen olan hastalardan plasenta ve zarlar ayrıldıktan sonra plasental yatak bi¬yopsisi alındı. Plasental yatak biyopsileri histo-patolojik olarak incelenerek uteroplasental vas-küler patolojiler değerlendirildi. Fetal gelişimi normal olan olguların tümün¬de (%100), İUGG olgularının %45'inde pla¬sental yatak biyopsisinde fizyolojik değişiklik¬ler saptandı. Kontrol, normal uterin arter Doppler ve patolojik uterin arter Doppler bul¬gusu olan İUGG olgularının sırasıyla %0, %16 ve %82'sinin plasenta yatak biyopsilerinde pa¬tolojik değişimler saptandı. Çalışmamızda uterin arter Dopplerinde çentiklenme ve/veya S/D oranında yükselme ile plasental yatak biyopsisindeki patolojik bul¬gular arasında yakın ilişki olduğunu gördük. Bulgularımız, intrauterin gelişme geriliğinde, plasentasyondaki bozuklukların uterin arter Dopplerindeki patolojilere dayanılarak, antena¬tal olarak belirlenebileceğini göstermektedir.

The comparison of uterine artery doppler velocimetry with the histopathology of the placental bed

The aim of this study was to determine the relationship between placental bed biopsy findings and uterine artery doppler flow parameters in intrauterine growth retardation(IUGR). We tested the hypotesis that Doppler velocimetry of the uterine artery in cases of fetal intrauterine growth retardation can reflect the presence of vascular maladaptation to pregnancy. Uterine artery doppler velocimetry was obtained in 47 consecutive pregnancies with IUGR and 26 unevetful control pregnancies. Abnormal uterine doppler velocimetry was defined as an average of S/D ratio>2.6 and distolic notching. In cases of C/S, after removal of the placenta, a placental bed biopsy, containing the uteroplacental vessels of the decidual and inner myometrial layer, was taken. The bed biopsies were examined for uteroplacental vascular pathological features. Results.- The physiological changes in the spiral arteries was seen in all (100%) AGA fetuses, in 45% of IUGG cases. The pathologicall changes in the placental bed biopsy was found %0 for controls, % 16 for growthrestricted fetuses with normal uterine artery Doppler, and % 82 for IUGR fetuses with abnormal uterine artery Doppler. Conclusion.- These data suggest that Doppler velocimetry of the uterine arteries is predictive of vascular lesions in growth-restricted fetuses.

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