Metin KABA, Leyla MOLLAMAHMUTOĞLU, Yaprak ÜSTÜN ENGİN, Elif Gül EYİ YAPAR

DÜŞÜK RİSKLİ GEBELİKLERDE KARDİYOTOKOGRAFİK İNTRAPARTUM FETAL DİSTRESS TANISINDA ERKEN PERİNATAL SONUÇLAR

Amaç: Düşük riskli term gebelerde intrapartum eksternal kardiyotokografide fetal distress tanısıyla acil sezaryenle doğurtulan fetusların doğum sonrası sonuçlarını değerlendirmektir. Gereçler ve Yöntem: Kohort çalışma 1 Ocak-31 Aralık 2010 tarihleri arasında Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesinde gerçekleştirildi. Çalışmaya alma kriterleri: bilinen riskli gebeliğin olmaması, gebelik haftasının 37 hafta ve üzerinde olması, tekil primigravit gebelikler, baş prezentasyonu; doğum eylemi takibi sırasında fetal distress tanısı ile acil sezaryenle doğum yaptırılması olarak belirlendi. Ortalama maternal yaş 26,3±5,3 yıl, ortalama maternal beden kitle indeksi 28± 5 kg/M2, ortanca gebelik sayısı bir 1 , gebelik haftası 39 ± 1 hafta idi. Fetal monitorizasyon Philips fetal kardiyotokografik series 50A cihazı ile kan gazı analizi otomatik kan gazı analizer S1-S2 Fluid Pack Cobass b 221 Roche Omnis. Roche Diagnostics GmbH, Avusturya cihazı ile yapıldı. Fetal distress kriteri olarak 30 dakika içinde tekrarlayan ve dakikada 70 atımın altına düşüp 60 saniyeden uzun süren deselerasyonlar alındı. Fetal metabolik asidoz tanımı pH

Anahtar Kelimeler:

Fetal distress, kardiyotokografi, hipoksi, fetal asidoz, yenidoğan yoğun bakım ünitesi

EARLY PERINATAL OUTCOME IN THE DIAGNOSIS OF CARDIOTOCOGRAPHIC INTRAPARTUM FETAL DISTRESS IN LOW RISK PREGNANCY

Aim: To evaluate outcome of fetuses who were delivered with emergency cesarean section for results fetal distress based on external fetal cardiotocography. Materials and Method: A chort study was designed to evaluate early perinatal outcome of fetuses who were delivered with emergency cesarean seation for fetal dirtress on cardiotocography. The study was performed between January 1, 2010 to December 31, in 2010 at Zekai Tahir Burak Womens’ Health Education and Research Hospital. Inclusion criteria’s were: singleton fetuses in primigravids, no high risk factor, gestational age greater than 37 weeks, vertex presentation and fetal distress necessitating cesarean in labor. Fetal distress criteria were: recurrent or prolonged deceleration of fetal heart rate under 70 beats/ minute lasting 60 seconds or more & continuing at least 30 minutes. Philips fetal cardioticography Series 50A was used for fetal cardiotographic monitoring. Fetal blood sample was analyzed with automatic blood gas analyzer. S1-S2 Fluid Pack Cobass b 221 Roche Omni s. Roche Diagnostics GmbH in Austria . Fetal metabolic acidosis was defined as a pH

Keywords:

Fetal distress, cardiotocography, hypoxia, fetal acidosis, newborn intensive care unit,

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Weale NK, Kinsella SM. Intrauterine fetal resuscitation. Anaesthesia Intensive Care 2007; 11(7): 282-85.
Rosén KG, Amer-Wåhlin I, Luzietti R, Norén H. Fetal ECG waveform analysis. Best Pract Res Clin Obstet Gynaecol 2004;18(3):485-514.
Ayres-de-Campos D, Ugwumadu A, Banfield P, Lynch P, Amin P, Horwell D, et al. A Randomised clinical trial of intrapartum fetal monitoring with computer analysis and alerts versus previously available monitoring. BMC Pregnancy. Childbirth 2010; 10:71.
Westgate JA, Wibbens B, Bennet L, Wassink G, Parer JT, Gunn AJ. The intrapartum deceleration in center stage: a physiologic approach to the interpretation of fetal heart rate changes in labor. Am J Obstet Gynecol 2007; 197(3):236.e1-11
Mahendru AA, Lees CC. Is intrapartum fetal blood sampling a gold standard diagnostic tool for fetal distress? Eur J Obstet Gynecol Reprod Biol 2011;156(2):137-9.
Chandraharan E, Arulkumaran S. Prevention of birth asphyxia: responding appropriately tocardiotocograph (CTG) traces. Best Pract Res Clin Obstet Gynaecol 2007; 21(4): 609-24.
Klauser CK, Christensen EE, Chauhan SP, Bufkin L, Magann EF, Bofill JA, et al. Use of fetal pulse oximetry among high-risk women in labor: A randomized clinical trial. Am J Obstet Gynecol 2005;192(6):1810-7
Neldam S, Osler M, Hansen PD, Nim J, Smith SE, Hertel J. Intrapartum fetal heart rate monitoring in a combined low and high-risk population: a controlled clinical trial. Eur J Obstet. Gynecol Reprod Biol 1986; 23(1-2):1-11.
Chen HY, Chauhan S, Ananth C, Vintzileos A, Abuhamad A. Electronic fetal heart rate monitoring and infant mortality in the United States. Am J Obstet Gynecol 2011; 204(6): 491 .e1-10.
Kühnert M, Schmidt S. Intrapartum management of nonreassuring fetal heart rate patterns: A randomized controlled trial of fetal pulse oximetry. Am J Obstet Gynecol 2004;191(6):1989-95
Graham EM, Ruis KA, Hartman AJ, Northington FJ, Fox HE. A systematic review of the role of intrapartum hypoxia ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 2008; 199(6):587-95.
Locatelli A, Incerti M, Ghidini A, Greco M, Villa E, Paterlini G. Factors associated with umbilical artery acidemia in term infants with low Apgar scores at 5 min. Eur J Obstet Gynecol Reprod Biol 2008; 139(2):146-50.
Huang BY, Castillo M. Hypoxic-ischemic brain injury: imaging findings from birth to adulthood. Radiographics 2008;28(2):417-39.
Johnston MV, Trescher WM, Ishida A, Nakajima W. Neurobiology of hypoxic-ischemic injury in the developing brain. Pediatr Res 2001;49(6):735–741.
Bick D; Caesarean Section. Clinical Guideline. National Collaborating Centre for Women's and Children's Health. Worldviews Evid Based Nurs 2004;1(3):198-99