İlk trimester sonrasında görülen minör abdominal travmanın gebeliğe etkileri

Amaç: Gebelik sırasında abdominal travmaya maruz kalmak sık görülen bir durumdur ve özellikle gebeliğin son döneminde risk artar. Bu çalışma gebeliği sırasında minör abdominal travma geçirmiş hastaları ve takiplerini sunarak travmanın gebeliğe olan etkilerinin incelenmesi amacıyla yapılmıştır. Gereç ve Yöntem: Kliniğimize 2006 ile 2011 yılları arasında minör abdominal travmayla başvuran 29 gebe retrospektif olarak incelendi. Gebeliğinin ilk trimesterinde olan ve majör travma geçirenler incelemenin dışında tutulmuştur. Hastaların yaş ortalaması 27.3±5.9 (yaş aralığı 18-38) olup, travma anında gebelik haftası ortalama 26.4±6 (14-39 hafta arası) hafta idi. Etiyolojide 13 (%45) hastada basit düşme (ev kazaları), 9 (% 31) hastada araç içi trafik kazası, 4 (%13.7) hastada karnına direkt darbe, 2 (%6.8) hastada araç dışı trafik kazası ve bir (%3.4) hastada darp olarak saptandı. Bütün hastalara fizik ve jinekolojik muayene yapıldı. Tam kan sayımı, tam kan biyokimyası, tam idrar tetkiki, 24 hafta ve üzeri gebelere non stres test (NST) ve obstetrik ultrasonografi yapıldı. Gözlem amaçlı yatışı kabul etmeyen 3 hasta dışında tüm hastalar en az 24 saat izlendi. Bulgular: Jinekolojik muayenede hiçbir hastada vajinal kanama saptanmadı. Obstetrik ultrasonografik değerlen- dirmede plasenta ile ilgili kanama veya başka bir anormallik izlenmedi. Bir hasta dışında tokolitik tedavi gerekmedi. Travma nedeniyle hiçbir hastada gebelik sonlandırılmadı. Doğan tüm bebekler sağlıklı idi. Sonuç: Bu çalışmada, ilk trimester sonrasında oluşan minör abdominal travmalarda gebenin ultrasonografik ve jinekolojik değerlendirilmesinde anormallik saptanmazsa, minör travmanın anne ve bebek için major bir komplikasyon yaratmadığı gözlemlendi. Bu nedenle, endişe ve panik içinde gelen minör abdominal travmalı gebeler konu hakkında bilgilendirilmelidir. Bu hastalarda 24 saatlik izlem yeterli olabilmektedir.

The effects of minor abdominal trauma in pregnency after the first trimester

Introduction: Exposure to abdominal trauma during pregnancy is frequent and increases risk of abortion especially in the last trimester. The purpose of this study is to evaluate the effects of minor trauma on pregnancy. Materials and Methods: We retrospectively evaluated 29 pregnant women who were admitted to our clinic with minor abdominal trauma between 2006 and 2011. First trimester pregnant women and patients who had been exposed to major trauma were excluded from the study. The mean age and gestational age at the time of trauma were respectively 27.3±5.9 (age range: 18-38) years and 26.4±6 (14-39) weeks. Etiologic factors were a simple fall in 13 patients (45%), motor vehicle accident in 9 patients (31%), a direct blow to the abdomen in 4 patients (13.7%), blow with motor vehicle in 2 patients (6.8%) and a beating in one patient (3.4%). Physical and gynecologic examination were performed to all patients. A complete blood count and biochemistry, total urinalysis, non stress test (NST, later than 24 weeks gestational age) and obstetric ultrasonography were evaluated. All patients, except 3 who did not consent, were hospitalized for observation for at least 24 hours. Results: There was no vaginal and placental hemorrhage or any other abnormality determined during the gynecologic exam and obstetric ultrasonographic observation. There was no necessity for tocolytic treatment except one patient. Gestational termination was not performed on any of the patients because of the trauma and all newborns were healthy. Conclusion: In this study, it was observed that there was no major complication either to mother or baby if there was no abnormality at the ultrasonographic and gynecologic evaluation for minor abdominal trauma. Therefore, pregnant women who are referred to the hospital with exposure to minor abdominal trauma after the first trimester in an apprehensive and panic status should be informed of this situation and observation for 24 hours can be sufficient.

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