Servikal uzunluğun postterm gebelikte doğum indüksiyonuna etkisi

Amaç: Çalışmanın amacı postterm gebelerde doğum indüksiyonu öncesi ölçülen servikal uzunluğun, doğum zamanına ve travay boyunca indüksiyon için verilen oksitosin dozuna olan etkisini araştırmaktır. Gereç ve Yöntem: Prospektif olarak yapılan bu çalışmaya postterm 87 gebe dahil edilmiştir. Gebelere oksitosin ile doğum indüksiyonu öncesinde servikal uzunluk ölçümü yapılmıştır. Servikal uzunluğun doğuma kadar geçen süre, toplam oksitosin dozu parametreleri ile ilişkisi incelenmiştir. Konfonder faktörlerin etkisi logistik regression analizi ile belirlenmiştir. Bulgular: Hastaların 65’i (%74.71) normal vajinal yolla, 22’si (%25.29) sezaryen ile doğum yapmıştır. Parite, Bishop skoru, servikal uzunluk ve fetal ağırlık değişkenleri oksitosin dozunu %67 oranında predikte ettiği saptandı (R-square = 0.675). İndüksiyon öncesi ölçülen servikal uzunluğu >32 mm olan hastaların, serviksi 32 mm’den kısa olanlara göre sezaryen olma olasılığı daha yüksek olarak saptandı (OR:3.7). Bu değişkenlerden en büyük etkiyi parite göstermekteydi (β = -.40, p <.001). Sonuç: Servikal uzunluk; doğum eylemi indüksiyonu, toplam oksitosin dozu ve doğum süresi için iyi bir ultrasonografik belirleyicidir. Klinik uygulamalarda yaygın kullanılmamasına rağmen zaman geçtikçe indüksiyon başarısı açısından kullanımı yaygınlaşacaktır.

Anahtar Kelimeler:

Doğum indüksiyonu, postterm gebelik, servikal uzunluk, transvajinal ultrason

Effect of cervical length on the induction of labor in postterm pregnancy

Purpose: This study aims to investigate the effect of cervical length measured before induction of labor on the duration of labor and oxytocin dose administered for induction during labor in post-term pregnant women. Materials and Methods: Eighty-seven post-term pregnant women were included in this prospective study. Cervical length was measured before the induction of labor with oxytocin. The relationship between cervical length and the time until delivery and total oxytocin dose parameters were examined. The effect of confounder factors was determined by logistic regression analysis. Results: Sixty-five (74.71%) of the patients gave birth by normal vaginal delivery and 22 (25.29%) by cesarean section. It was found that parity, bishop score, cervical length and fetal weight variables predicted oxytocin dose by 67% (R-square = 0.675). Patients with a cervical length of >32mm measured before induction were more likely to have a cesarean section than those with a cervix shorter than 32 mm (OR:3.7). Parity had the greatest effect among these variables (β = -.40, p <.001). Conclusion: Cervical length is a useful marker in predicting the success of labor induction with oxytocin in post-term pregnant women. The total oxytocin dose used in labor induction is related to cervical length.

Keywords:

Cervical length, postterm pregnancy, transvaginal ultrasound,

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