Özgür Volkan AKBULUT, Görker SEL, Aykut BARUT

İlk trimester doppler ultrasonografinin kromozomal anomaliler ve gebelik prognozunu tahmin etmedeki etkinliği

Amaç: 11-13+6 gebelik haftalarında yapılan Doppler ultrasonografik muayene bulgularının, fetal kromozomal anomaliler, gebelik-doğum prognozu ve yeni doğan yoğun bakım ihtiyacını tahmin etmedeki etkinliğinin araştırılması.Gereç ve Yöntem: Çalışma Mart 2005 -Mart 2006 tarihleri arasında, BEÜ Kadın Doğum gebe polikliniğine başvuran sağlıklı gebeler ile yapılmıştır. 11-13+6 haftalık, fetal kalp aktivitesi pozitif, tekil gebeliği mevcut olan 130 gebe çalışmaya alınmıştır. Yapılan ultrasonografik sırasında fetüsün değerlendirilmesi, fetal baş-popo mesafesi, fetal ense saydamlığı, servikal uzunluk ve uterin - umbilikal arter Doppler ölçümleri yapılmıştır. Hastaların tamamı doğuma kadar takip edilerek, gebelik, doğum sonucu ve yeni doğan yoğun bakım ihtiyacı belirlenmiştir. İstatistikler SPSS 19 programında, Mann-Whitney U ve T test kullanılarak yapılmıştır.Bulgular: 130 gebenin 117’si %90 miad doğum yaptı, 9’unun %6,9 37 hafta altı doğum yaptığı tespit edildi. 126 hastanın 49’nun doğumu normal vajinal yoldan, 77’sininki sezaryen ile gerçekleşmiştir. Yapılan izlem sonucu, 4 gebelik anormal olarak seyretti. Artmış fetal ense saydamlığı nedeniyle amniyosentez yapıldı. Sonucunda da 3 fetüste trizomi 21, 1 fetüste trizomi 18 saptandı ve terminasyon yapılmıştır. Amniyosentez sonucu fetal kromozomal anomali saptanan fetüslerin umbilikal arter Pulsalite İndeks PI ortalaması 3,00±0,62 olarak hesaplandı. Diğer 126 fetüsün umbilikal arter PI ortalamaları 2,55±0,83 idi. Bu iki grubun umbilikal arter PI ortalamaları arasındaki farkın anlamlı olduğu saptandı p: 0.026 .Sonuç: Umbilikal akımının Doppler çalışmaları, fetoplasental dolasımın perfüzyonu hakkında, indirek fakat güvenilir bilgi sağlar ve gebeliğin ilk yarısında da faydalıdır. Bu çalışma sonucunda elde edilen bulgular umbilikal arter PI’ nin fetal kromozomal anomalileri taramada NT ile kombine edildiğinde 11-13+6 haftada yapılacak tarama sırasında yeni bir ek kriter olarak kullanılabileceğini düşündürmektedir

Anahtar Kelimeler:

Ense saydamlığı, fetal kromozomal anomali, servikal kanal uzunluğu doppler, ultrasonografi, gebelik prognozu, apgar, yeni doğan yoğun bakım ihtiyacı

First trimester Doppler ultrasound and prediction of chromosomal anomalies and prognosis of pregnancy

Objective: To investigate the importance of ultrasonography in predicting fetal chromosomal anomalies, gestational prognosis and the necessity for newborn intensive care at 11-13+6 th gestational weeks.Material and Methods: The study was conducted on healthy pregnants applied to BEU maternity pregnant clinic between March 2005 and March 2006. 130 pregnant, with a gestation of 11-13+6 weeks and single pregnancy were included to the study. The measurement of fetal crown rump length, nuchal translucency, cervical length and Doppler evaluation of umbilical and uterine artery were performed. The patients were followed till birth. Statistical analysis were done by SPSS 19 program with Mann-Whitney U and T test.Results: 117 of 130 patients were detected to give term birth. Vaginal labor was performed in 49 pregnant whereas cesarean section was performed to 77 patients. The mean value of PI of umbilical artery was calculated as 3.00±0.62 in fetus with chromosomal anomaly according to the result of amniocentesis. The mean values of PI of umbilical artery were 2.55 +0.83 of the other 126 fetus p: 0.026 .Conclusion: Doppler evaluations of umbilical flow provide indirect but reliable information about fetoplacental circulation, which is beneficial even in the first half of pregnancy. The trend of pulsatility index of umbilical artery has been found to be abnormally elevated in trisomic fetus at early pregnancy in previous studies. This data supports the idea that the combination of the PI of umbilical artery and fetal nuchal translucency might be used as a new criterion in predicting fetal chromosomal anomalies at 11-13+6th gestational weeks

Keywords:

Fetal nuchal translucency fetal chromosomal anomaly, cervical length, doppler, ultrasonography, prognosis of pregnancy, apgar, necessity for newborn intensive care,

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Z Alfirevic, T Stampalija, N Medley. Fetal and umbilical Doppler ultrasound in normal pregnancy. The Cochrane Library, 2015.doi:10.1002/14651858.CD001450.pub4.
Khong SL, Kane SC, Brennecke SP, da SilvaCosta F. First-trimester uterineartery Doppler analysis in thepre- diction of laterpregnancycomplications. DisMarkers 2015; 2015: 679730.
Velauthar L, Plana MN, Kalidindi M, Zamora J, Thilaganat- han B, Illanes SE, Khan KS, Aquilina J, Thangaratinam S. First‐trimester uterineartery Doppler andadversepregnan- cyoutcome: a meta‐analysisinvolving 55 974 women. Ultra- sound in Obst Gynecol 2014;43:500-7.
Crovetto F, Crispi F, Scazzocchio E, Mercade I, Meler E, Figueras F, Gratacos E. First‐trimester screeningforearl- yandlatesmall‐for‐gestational‐ageneonatesusing mater- nal serum biochemistry, bloodpressureanduterineartery Doppler. Ultrasound in Obst Gynecol 2014;43:34-40.
Van den Elzen HJ, Cohen –Overbeek TE, Grobbee DE, Qu- artero RW,Wladimiroff JW. Early uterine artery Doppler velocimetry and the outcome of pregnancy in women aged 35 years and older. Ultrasound Obstet Gynecol 1995;5:328- 33.
Martinez JM, Antolin E, Borrell A, Puerto B, Casals E, Oju- el J, Fortuny A. Umbilical Doppler velocimetry in fetuses with trisomy 18 at 10–18 weeks’ gestation. Prenat Diagn 1997;17:319-22.
Van Baaren GJ, Vis JY, Wilms FF, Oudijk MA, Kwee A, Po- rath MM et al. Predictive value of cervical length measure- ment and fibronectin testing in threatened preterm labor. Obst Gynecol 2014;123:1185-92.
Palacio M, Caradeux J, Sanchez M, Cobo T, Figueras F, Coll O, Gratacos E, Cararach V. Uterinecervicallengthmeasure- menttoreducelength of stay in patientsadmittedforthreate- ned preterm labor: a randomizedtrial. Fetal diagnosisandt- herapy. 2018;43:184-90.
Berghella V, Palacio M, Ness A, Alfirevic Z, Nicolaides KH, Saccone G. Cervicallengthscreeningforprevention of pre- term birth in singletonpregnancywiththreatened preterm labor: systematicreviewand meta‐analysis of randomize- dcontrolledtrialsusingindividualpatient‐leveldata. Ultra- sound in Obst Gynecol 2017;49:322-9.
Ertan AK, Tanrıverdi HA, Schmidt W. Doppler Sonography in Obstetrics. In:Chervenak FA, Kurjak A, Jaypee Brothers., editors. In: Ian Donald Textbook of Ultrasound in Obstet- rics and Gynecology. New Delhi, Hindistan: 2003: 395-421.
Nicolaides KH, Heath V, Spencer K, Nix AB. Nuchal trans- lucency and gestational age. Prenat Diagn 2004;24:833-4; author reply 834-5.
Brown R, DiLuzio L, Gomes C, Nicolaides KH. Theumbi- licalartery pulsatility index in thefirst trimester: is there an associationwithincreasednuchaltranslucencyorchromoso- malabnormality?.Ultrasound in ObstetricsandGynecology: TheOfficialJournal of the International Society of Ultra- sound in Obst Gynecol 1998;12:244-7.
Martinez JM, Borrell A, Antolin E, Puerto B, Casals E, Ojuel J, Fortuny A. Combining nuchal translucency with umbilical Doppler velocimetry for detecting fetal trisomies in the first trimester of pregnancy. BJOG: An Int J Obs Gy- naecol 1997;104:11-4.
Borrell A, Martinez JM, Farre MT, Azulay M, Cararach V, Fortuny A. Reversed end-diastolic flow in first-trimester umbilical artery: an ominous new sign for fetal outcome. Am J Obst Gynecol 2001;185:204-7.
Sheppard C, Platt LD. Nuchal translucency and Şrst trimes- ter riskassessment: a systematic review. Ultrasound Q 2007; 23:107–16.
Xin Yang, Ru Li, Fang Fu, Yongling Zhang, Dongzhi Li, Can Liao. Submicroscopic chromosomal abnormalities infetu- ses with increased nuchal translucency and normal karyot- ype. J Matern Fetal Neonatal Med 2016;19:1–5.
Harrington K. Goldfrad C, Carpenter RG, Campbell S. Transvaginal uterine and umbilical artery Doppler exami- nation at 12-16 weeks and the supseguent development of PET and intrauterine growth retardation. Ultrasound Obs- tet Gynecol 1997;9:94-100.
Cnossen JS, Morris RK, ter Riet G, Mol BW, van der Post JA, Coomarasamy A, Zwinderman AH, Robson SC, Bindels PJ, Kleijnen J, Khan KS. Use of uterineartery Doppler ultra- sonographytopredictpre-eclampsiaandintrauterinegrowth- restriction: a systematicreviewandbivariable meta-analysis. Cmaj 2008;178:701-11.
Gudmundsson S, Flo K, Ghosh G, Wilsgaard T, Acharya G. Placental pulsatility index: a new, moresensitiveparame- terforpredictingadverseoutcome in pregnanciessuspected of fetal growthrestriction. Actaobstetricia et gynecologica Scandinavica 2017;96:216-22.
Ghosh GS, Gudmundsson S. Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth‐restricted fetuses. BJOG: An Int J Obst Gynaecol 2009;116:424-30.