Füsun KARBANCIOĞLU CANTÜRK, Selda SONGUR DAĞLI

Maternal Aneminin Perinatal Sonuçlara Etkisi

Amaç: Çalışmamızın amacı hastanemizde doğum yapan anemisi olan gebelerde anemi ile kötü perinatal sonuçlar arasındaki ilişkiyi incelemek ve maternal aneminin önemine dikkat çekmektir.Gereç ve Yöntemler: Çalışmaya 1 Ocak 2017 -31 Aralık 2017 tarihleri arasında Kırşehir Ahi Evran Üniversitesi Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde doğum yapan düşük riskli gebeler dahil edildi ve veriler retrospektif olarak değerlendirildi. Çalışma grubu, doğum için başvuru anındaki hemoglobin düzeyi ile 2. trimestırda bakılmış hemoglobin düzeyi 0,05 . Anemik grupta sezaryenle doğum oranı istatistiksel olarak anlamlı derecede yüksek bulunmasına rağmen p=0,035 , primer sezaryen oranları arasında fark bulunamadı p>0, 05 . Anemik grupta en sık primer sezaryen endikasyonu fetal distress iken kontrol grubunda ise ilerlemeyen eylem ve sefalopelvik uyumsuzluk olarak saptandı.Sonuç: Bizim çalışmamıza göre gebelerde hafif anemi kötü perinatal sonuçlara yol açmamaktadır.

Anahtar Kelimeler:

Gebelik, anemi, perinatal sonuçlar

Effects of Maternal Anemia on Perinatal Outcomes

Aim: The aim of our study is to examine the relationship between anemia and adverse perinatal outcomes of pregnant women with anemia who delivered at our hospital and to attract attention to the importance of maternal anemia.Material And Methods: The low risk pregnant women who delivered at Obstetrics and Gynecology Clinic, Kırsehir Ahi Evran University Training and Research Hospital between January 1st 2017 and December 31th 2017 were included in the study and data was analyzed retrospectively. Pregnant women, whose hemoglobin levels were below 11 g /dl both during labor and at 2nd trimester constituted the study group. Every 5th laboring women recorded in the medical records at the same time interval whose hemoglobin level was 11 g /dl or above during labor and at 2nd trimester constituted the control group and randomization was achieved. Both of the groups were compared in terms of obstetric and neonatal outcomes.Results: 554 pregnant women 257 in study group and 297 in control group were included in the study. There was no statistically significant correlation between maternal hemoglobin level, age and parity. There was no statistically significant difference between the groups in terms of age, parity, mean birth weight, rate of low birth weight, 1st and 5th minutes Apgar scores, rate of intrauterine growth restriction, preterm labor. p>0,05 . Although cesarean delivery rate was significantly higher in anemic group p=0,035 , there was no statistically difference in primary cesarean section rate between two groups p>0,05 . Fetal distres was the most frequent primary cesarean indication in anemic group whereas cephalopelvic dissociation and failure to progress in labor in the control group.Conclusion: Mild anemia is not associated with adverse perinatal outcomes according to the results of our study.

Keywords:

Pregnancy, anemia, perinatal outcome,

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Balarajan Y, Ramakrishnan U, Azaltin E, Shankar AH, Subramanian SV: Anaemia in low-income and middle-income countries. Lancet 2013, 378:0140–6736.
T.C. Başbakanlık Devlet Planlama Teşkilatı Ulusal Gıda ve Beslenme Stra- tejisi Çalışma Grubu Raporu. 2003.s43.DPT:2670
World Health Organization. The prevalence of anemia in women: A tabu- lation of available information.2nded.Geneva, Switzerland, WHO, 1992.
WHO.Diet nutrition and the prevention of chronic diseases. WHO Techni- cal Report Series. Geneva 1990;7.
Sak ME, Özkul Ö, Evsen MS, Sak S, Evliyaoğlu O: Gebelik Anemisinin Perinatal Sonuçlara Etkisi. Dicle Tıp Dergisi 2009:36(1):39-42.
Rasmussen KM: Is There a Causal Relationship between Iron Deficiency or Iron-Deficiency Anemia and Weight at Birth, Length of Gestation and Perinatal Mortality? The Journal of Nutrition. 2001,131(2): 590–603
Lone FW, Qureshi BN ,Emanuel F: Maternal anaemia and its impact on pe- rinatal outcome: Tropical Medicine and International Health. 2004; 9(4): 486–490.
UJ Bakhtiar, Y Khan, R Nasar : Relationship between maternal hemoglo- bin and perinatal outcome. RMJ. 2007; 32(2): 102-104.
Fleming AF: A Study of Anemia of Pregnancy in Ibadan, Western Nigeria with Special Reference to Folic Acid Deficieny. MD Thesis, University of Cambridge. 1991 Quoted by A. Hughes in ‘ Anemia of Pregnancy’ Mater- nal Health and Safe Motherhood, WHO,1991.
Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol 2005;122:182-186.
Lao TT, Pun TC: Anemia in pregnancy-is the current definition meaning- ful? Eur J Obstet Gynecol Reprod Biol 1996;68:53-8.
Working group on infant growth. An evaluation of infant growth; the issue and interpretation of anthropometry in infants. WHO Bull. 1995;73:165- 174.
Klebanoff MA, Shiono PH, Berendes HW, Rhoads GG, Facts and artifacts about anemia and preterm delivery. JAMA 1989;262:511-15.
Malhotra M, Sharma JB, Batra S, SharmaS, Murthy NS, Arora R. Maternal and perinatal outcome in varying degrees of anemia. Int J Gynaecol Obs- tet 2002;79:93-100.
Steer P,Alam Ash M, Wadsworth J, Welch A. Relation between maternal hemoglobin concentration and birth weight in different ethnic groups. Br Med J 1995;310(6978):489-491.
Blankson ML, Goldenberg RL,Cutter G,Cliver SP,The relationship between maternal hematocrit and pregnancy outcome: black-white differences. J Natl Med Assoc 1993;85:130-4.
Lu ZM, Goldenberg RL, Cliver SP, Cutter G, Blankson M. The relationship between maternal hematocrit and pregnancy outcome . Obstet Gynecol 1991;77:190-4.
Mola G, Permezel M, Amoa AB, Kluffo CA. Anemia and perinatal outcome in Port Moresby. Aust NZ J Obstet Gynecol 1999;39(1):31-4.
Murphy JF, O Riordan J, Newcombe RG, Coles EC, Pearson JF. Relation of hemoglobin levels in first and second trimasters to outcome of pregnan- cy. Lancet 1986;1(8488):992-5.
Scholl TO, Hediger ML, Fischer RL, Shearer JW. Anemia vs iron deficien- cy: increased risk of preterm delivery in a prospective study. Am J Clin Nutr 1992;55:985-8.
Schwartz WJ, Thurnau GR. Iron deficieny anemia in pregnancy. Clin Obs- tet Gynecol 1995;38(3):443-54.
Bashiri A,Burstein E, Sheiner E, Mazor M. Anemia during pregnancy and treatment with intravenous iron : current review of the literatüre. Eur J Obstet Gynecol Reprod Biol 2003;110:2-7.
Garn SM, Ridella SA,Petzold AS, Falkner F. Maternal hematological levels and pregnancy outcomes. Semin Perinatol 1981;5:155-62.
ChangSC, O Brien KO, Nathanson MS, Mancini J, Witter FR, Hemoglobin concentrations influence birth outcomes in pregnant African-American adolescents. J Nutr 2003;133:2348-55.
Tunç SY,Görük NY, Ceylan B, Tunç N. Kadın doğum polikliniğine başvuran kadınlarda gebelik ve demir eksikliği anemisi ilişkisi J Clin Exp Invest 2012; 3 (1): 49-52.
Cunnigham FG, Gant GF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstrom KD. Williams Obstetrics. 21st ed. McGraw-Hill; 2001:1301-16.
Bondevik GT, Lie RT, Ulstein M, Kvale G. Maternal hematological status and risk of low birth weight and preterm delivery in Nepal. Acta Obstet Gynecol Scand 2001;80: 402-408.
Xiong X, Buekens P, Alexander S, Demianczuk N, Wollast E. Anemia during pregnancy and birth outcome: A meta-analysis. Am J Perina- tol. 2000;17(3):137-46
Park Y-S, Hoh J-K. Complex and irregular heart rate dynamics in fetuses compromised by maternal anemia as a high risk pregnancy. J.Perinat. Med.2015;43(6):741-748.