Rıza MADAZLI, Verda ALPAY, Didem KAYMAK, İpek Betül ÖZÇİVİT

ERKEN VE GEÇ BAŞLANGIÇLI FETAL GELİŞİM KISITLILIĞINDA PERİNATAL SONUÇLAR VE PROGNOSTİK FAKTÖRLER

Amaç: Erken (EB) ve geç (GB) başlangıçlı fetal gelişim kısıtlılığı (FGK) olgularında obstetrik ve perinatal sonuçların değerlendirilmesi ve perinatal sağ kalım ile olumsuz perinatal sonuçlar üzerine etkili prognostik faktörlerin saptanması. Gereç ve Yöntem: Tekil 105 EB- ve 55 GB-FGK olan gebelik retrospektif olarak derlendi. Umblikal arter (UA), orta serebral arter (MCA) ve duktus venozus (DV) Doppler parametreleri ile serebroplasental oran (CPR) değerlendirildi. Doğumdaki gebelik haftası, doğum ağırlığı ve Doppler parametrelerinin prognostik anlamı incelendi. Bulgular: Doğumun 27. gebelik haftasından sonra gerçekleşmesi (duyarlılık %87,5, özgüllük %76) ve doğum ağırlığının 665 gr’ın üzerinde olması (duyarlılık %88,8, özgüllük %92) EB-FGK olgularında en iyi sağ kalım öngörüsünü sağladı. Lojistik regresyon analizinde, UA diyastol sonu akımın (EDF) kaybı ve ters akım olması, anormal DV Doppler ve DV a dalgasının kaybı/ters a dalgası EB-FGK’da perinatal mortalite ile ilişkili bulundu (sırasıyla olasılık oranları %2,57, 6,97, 4,51 ve 8,75). Olumsuz sonuçların eşlik ettiği GB-FGK’da, normal sonuçların izlendiği olgulara kıyasla, CPR’ın 5. persentilin altında olma oranı istatiksel olarak anlamlı bulundu (p<0,001). Sonuç: EB-FGK’da doğumdaki gebelik haftası ve doğum ağırlığı en kuvvetli prediktörlerdir. GB-FGK’da, CPR’ın <5. persentil olması doğum komplikasyonları açısından artmış risk ile ilişkilidir.

Anahtar Kelimeler:

Erken başlangıçlı fetal gelişim kısıtlılığı, geç başlangıçlı fetal gelişim kısıtlılığı, perinatal sonuçlar, Doppler parametreleri

PERINATAL OUTCOMES AND PROGNOSTIC FACTORS IN EARLY AND LATE-ONSET FETAL GROWTH RESTRICTION

Objective: To evaluate the obstetric and perinatal outcomes of fetuses with early (EO) and late-onset (LO) fetal growth restriction (FGR), and to explore the prognostic factors on perinatal survival and adverse perinatal outcome. Materials and Methods: We retrospectively reviewed 105 EO and 55 LO-FGR singleton pregnancies. Umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler parameters and cerebroplacental ratio (CPR) were assessed. Prognostic significance of gestational age at delivery, birth weight and Doppler parameters were evaluated. Results: Gestational age at delivery greater than 27 weeks (sensitivity 87.5%, specificity 76%) and birth weight of 665 g (sensitivity 88.8%, specificity 92%) provided the best prediction of survival in EO-FGR. Logistic regression analysis of UA absent or reversed end diastolic flow (EDF), abnormal DV Doppler, and absent/reversed DV a-wave revealed Odds Ratios of 2.57, 6.97, 4.51 and 8.75 respectively for perinatal mortality in EO-FGR. The incidence of CPR below the 5th percentile was significantly higher in LO-FGR pregnancies with the composite adverse outcome than normal outcome (p<0.001). Conclusion: Gestational age at delivery and birth weight are the strongest predictors of perinatal mortality in EO-FGR. In LOFGR, CPR <5th percentile is associated with an increased risk of delivery complications.

Keywords:

Early-onset fetal growth restriction, late-onset fetal growth restriction, perinatal outcome, Doppler parameters,

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