Erol BASUGAY, Abdurrahman ÖNEN, Ahmet YALINKAYA, Murat YAYLA

Fetal Anomalilerde Beta-2 Mikroglobulin Düzeyleri ve Pre·Postnatal Ultrasonografi ile Tanı ve Takip

Amaç: Son yıllarda fetal anomalilerin prenatal tanı ve takibinde önemli ilerlemeler olmuştur . Çalışmamızda, fetal anomalilerin tanı ve takibinde ultrasonografi ve serum beta-2 mikroglobulin düzeyinin rolünü araştırdık. Yöntemler: Fetal anomali nedeniyle hastanemizde takip edilen 29 olgu çalışmaya alındı. Gebelere önce ultrasonografi yapıldı. Daha sonra, kordosentez ile fetal kan alınarak beta-2 mikroglobulin düzeyi ölçüldü. Karyotip tayini yapıldı. Postnatal fizik muayene ve ultrasonografi sonuçları ve bazı olgularda postnatal beta-2 mikroglobulin düzeyleri olguların antenatal tanıları ve serum beta-2 mikroglobulin düzeyleri ile karşılaştırıldı. Bulgular : Fetal anomalisi olan toplam 29 olgu prospektif olarak değerlendirildi. En çok multisistem anomalisi ve daha az sıklıkta üriner sistem, santral sinir sistemi ve gastrointestinal sistem anomalileri gözlendi. Fetal serum beta-2 mikroglobulin düzeyi olguların %76,5'inde 3 mg/dl'nin üzerinde tespit edildi. Postnatal ultrasonografi ve fizik muayenede olguların 8'inde herhangi bir anomaliye rastlanmadı. Kordosentez yöntemi ile alınan fetal kanda bakılan karyotiplemede 4 (%14) fetusta kromozomal anomali saptandı. Kromozomal anomalili fetusların %50'sinin anne yaşı 35 yılın üzerinde idi. Sonuçlar: Çalışmamızda, antenatal ultrasonografinin fetal anomalileri saptamadaki duyarlılığı %72 idi. Fetal serum beta-2 düzeyi fetal anomalili olguların %76'sında yüksek saptandı. Sonuç olarak, gebelikte belirli aralıklarla prenatal ultrasonografik incelemenin ve anomalili veya anomali şüphesi olan olgularda serum fetal beta-2 mikroglobulin düzeyinin ölçümü prenatal tanı ve takipte faydalı olabilir. Ancak, serum beta-2 mikroglobulin düzeyinin daha homojen bir anomali grubunda çalışılması daha objektif sonuçlar verecektir.

Follow-Up And Diagnosis With Pre - Postnatal Ultrasonography And Beta-2 Microglobulin Levels In Fetal Anomalies

Objective: Significant improvement in prenatal diagnosis and follow-up of fetal anomalies has occurred in recent years. In our study, we investigated the role of ultrasonography and serum beta-2 microglobulin level in the diagnosis of fetal anomalies. Method: A total of 29 cases who had fetal anomaly were investigated in our institution. Prenatal ultrasonography was done initially. Fetal blood sample was taken by cordocentesis and serum beta-2 microglobulin level was measured and karyotyping was done. The postnatal physical as well as ultrasonographic findings and in some cases, postnatal serum beta-2 microglobulin level were compared to antenatal diagnosis and fetal serum beta-2 microglobulin level. Results: Twenty-nine fetuses associated with fetal anomaly were reviewed prospectively. The most common type of anomaly was multysistem anomalies followed by urinary, central nervous and gastrointestinal system anomalies . Fetal serum beta-2 microglobulin level was greater than 3 mg/dl in 76.5% of fetuses. A total of 8 cases had no anomaly postnatally. A chromosomal abnorrnality was observed in 4 (14%) fetuses. The age of mother was older than 35 years in 50% of fetuses who had chromosomal abnormality . Conclusions: The sensitivity of prenatal ultrasonography for diagnosis of fetal anomalies was 72%. Fetal serum beta-2 microglobulin level was relatively high in three-fouth of fetuses. As a result, serial sonographic evaluation and measurement of serum beta-2 microglobulin may be beneficial in prenatal diagnosis as well as follow-up of fetuses associated with or has suspicion of fetal anomaly. However, serum beta-2 microglobulin might be more beneficial in a relatively homogenous fetal anomaly group.

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