Oluş APİ, Ayla AKTULAY, Burcu KARAKAYA KISA, Esra ÇELİK YAŞAR, Orhan ÜNAL, Ebru ERSOY, Ali Özgür ERSOY

Birinci Trimester Gebelikle İlişkili Plasma Protein-A Düzeyinin, İkinci Trimester Uterin Arter Doppler, Plasental Boyut ve Kötü Obstetrik Sonuçlarla İlişkisi

Amaç: Birinci trimester Down Sendromu taramasında 3. persentilin altında ( ≤0.30 Multiples of Median (MoM)) olan pregnancy associated plasma protein-A (PAPP-A)düzeyinin, ikinci trimester ortalama uterin arter (UtA) pulsatilite indeksi (PI) ile plasental boyut ölçümü ve kötü obstetrik sonuçlarla ilişkisini araştırmayı amaçladık.Gereç ve Yöntemler: Eylül 2010 ile Ocak 2011 tarihleri arasında Dr. Lütfi Kırdar Kartal Eğitim ve Araraştırma Hastanesi Perinatoloji polikliniğine başvuran birinci trimester tarama testinde PAPP-A düzeyi ≤ 0.30 düzeltilmiş MoM saptanan 32 (Grup 1), PAPP-A düzeyi >0.30 düzeltilmiş MoM saptanan 50 kadın (grup 2) çalışmaya dahil edildi. Gebeler 18-24 haftalarda plasenta boyut ölçümü ve UtA doppleri ile yeniden değerlendirildi. Artmış UtA direnç indeksi olarak ortalama UtA PI ≥1.45 anormalkabul edildi. Gebeler düşük PAPP-A ve artmış UtA PI (Grup 1:n=7) ve normal PAPP-A ve normal UtA PI (Grup 2:n=75) olarak tekrar gruplandı ve doğum sonrasıpreeklampsi, intrauterin gelişme geriliği (IUGG), oligohidramnios, erken doğum gibi gebelik komplikasyonları açısından sorgulandı.Bulgular: PAPP-A düzeyine göre gruplar karşılaştırıldığında kötü obsterik sonuçlar düşük PAPP-A grubunda fazla iken istatiksel olarak anlamlı fark yalnızca preeklampside izlendi (p=0.02). İkinci trimester plasenta boyutu ve UtA PI değerlerinde gruplar arasında anlamlı fark saptanmadı. Gebeler PAPP-A ve UtA PI değerinegöre gruplandığında düşük PAPP-A ve yüksek UtA PI grubunda IUGG (p=0.03), oligohidramnios (p=0.04) daha fazla, doğum kilosu daha düşüktü p=(0.02) ve farkistatistiksel olarak anlamlıydı, preeklampsi açısından anlamlı fark saptanmadı (p=0.23).Sonuç: Sonuçları iştir ki, plasental yetmezliğin anne ve fetus üzerindeki olumsuz etkilerini tahmin etmek mümkündür, ancak tek başına kullanılabilecek bir taramametodu yoktur. Kötü obstetrik sonuçları tarama amaçlı, biyokimyasal ve ultrasonografik parametreleri bir arada kullanan daha geniş randomize klinik çalışmalaraihtiyaç vardır.

Anahtar Kelimeler:

Pregnancy associated plasma protein-A, uterin arter doppler, preeklampsi, intrauterin gelişme geriliği

Relationship Between First Trimester Low Pregnancy Associated Plasma Protein A Levels With Second Trimester Uterine Artery Doppler, Placental Size and Adverse Obstetric Outcomes

Aim: We aimed to demonstrate the relationship between pregnancy associated plasma protein-A PAPP-A levels below 3th percentile ≤0.30 Multiples of Median MoM with second trimester placental size, mean Uterine Artery UtA doppler Pulsatility Index PI and adverse obstetric outcomes.Material and Methods: We recruited 32 women with PAPP-A levels ≤ 0.30 corrected MoM Group 1 , and 50 women with PAPP-A levels > 0.30 corrected MoM Group 2 , attended to Dr. Lütfi Kırdar Kartal Education and Research Hospital perinatology outpatient clinic, between September 2010 and January 2011. Pregnant women were reevaluated at 18-24 weeks with placental size measurement and mean UtA doppler indices. Mean UtA doppler PI ≥1.45 considered to be abnormal as increased UtA resistance. We also grouped women as low PAPP-A and increased mean UtA PI Group 1: n =7 and normal PAPP-A and normal mean UtA PI Group 2: n = 75 . All women are asked in postnatal period for pregnancy complications like preeclampsia PE , intrauterine growth retardation IUGR , preterm delivery, oligohydramniosis and stillbirth.Results: When women were grouped according to the PAPP-A level adverse pregnancy outcomes were more prevalent in low PAPP-A group but statistically significant difference was seen only in preeclampsia p=0.02 . Second trimester placental size and UtA PI levels were not significantly different between groups. When grouped according to the PAPP-A and UtA PI levels, IUGR and oligohydramniosis was significantly higher p= 0.03 and p=0.04 respectively and birth weight was significantly lower p=0.02 in low PAPP-A and high UtA PI group. There was no satistically significant difference in PE among groups p=0.23 .Conclusion: Our results have shown that it is possible to predict unfavorable effects of placental insufficiency on mother and fetus, but it is obvious that there is no single screening method. Randomised clinical trials with larger sample sizes using combination of biochemical and ultrasonographic parameters is necessary for prediction of adverse pregnancy outcomes.

Keywords:

Pregnancy associated plasma protein-A, uterine artery doppler, preeclampsia, intrauterine growth retardation,

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