Necati HANÇERLİOĞLU, Semra EROĞLU, Ayla AKTULAY, Yaprak ENGİN ÜSTÜN, Dilek UYGUR, Nuri DANIŞMAN

Servikal Serklaj Uygulaması: Retrospektif Analiz

Amaç: Servikal yetmezliğin tedavisinde en yaygın kullanılan yöntem serviksi kapatıcı sütür konmasıdır. Çalışmamızda servikal serklaj uyguladığımız olguları ve gebelik sonuçlarını değerlendirmek amaçlandı. Gereçler ve Yöntem: Hastanemizde 2007-2012 yılları arasında servikal yetmezlik tanısı konulan, McDonald tekniği ile serklaj yapılan hastaların gebelik sonuçları retrospektif olarak değerlendirildi. Profilaktik, terapötik ve acil serklaj uygulanan tüm hastalar n=41 çalışmaya dahil edildi. Daha önceden en az iki ve üzeri, sebebi bilinemeyen, servikal yetmezliğe bağlı oluştuğu düşünülen, spontan erken doğum ve ikinci trimester gebelik kaybı hikâyesi olan, 14-16. gebelik haftalarındaki hastalara profilaktik servikal serklaj uygulandı n:33 . Seri servikal kanal uzunluğu takibine alınan hastalarda ölçüm 15 mm ve altında ise terapötik serklaj yapılıp, yatak istirahati önerildi n:6 . Servikal açıklığı olan 2 olguya acil serklaj uygulandı n:2 . Hastaların yaşı, gebelik haftaları, gravida, parite, vücut kitle indeksi, gebelik sonuçları kaydedildi Bulgular: Hastaların ortalama yaşı 28,5+4,5 idi. Çalışmamızda serklaj uygulanan 41 hastadan 39’u tekil, 2’si ikiz gebelikti. 33 hastamıza profilaktik, 6’sına terapötik, 2 hastaya da acil serklaj operasyonu yapılmıştır. Proflaktik serklaj yapılan 33 hastanın 18 %54.54 ’inde miad doğum gerçekleşmiş, 10’unda preterm eylemle, 5 tanesi abortusla sonlanmıştır. Acil serklaj yapılan 2 hastanın her ikisinde de preterm doğum gerçekleşmiştir. 6 terapötik serklaj yapılan hastanın 2’si terme ulaşmış, 4 tanesi preterm doğum yapmıştır 2 tanesi ikiz gebeliktir . Sonuç: Profilaktik serklaj uygulanan hastaların %54’ü terme ulaşmıştır.

Anahtar Kelimeler:

Servikal serklaj, servikal yetmezlik, transvaginal ultrason, gebelik sonuçları

Cervical Cerclage Application: A Retrospective Analysis

Aim: The most widely used method in cervical insufficiency is applying a suture that closes the cervix. The aim of this study is to evaluate the cases which were applied cervical cerclage, and the outcomes of their pregnancies.Material and Method: The pregnancy outcomes of patients who were diagnosed with cervical insufficiency during 2007–2012 in our hospital and were applied cerclage with McDonald method were evaluated retrospectively. All the patients n=41 who were applied prophylactic, therapeutic and emergency cerclage were included in the study. For patients n=33 who had previously at least two or more spontaneous preterm deliveries and second trimester pregnancy losses, for reasons unknown, but thought to be related cervical insufficiency, prophylactic cerclage was performed during the 14-16th weeks of pregnancy. If the measurement was ≤ 15 mm in patients monitored for cervical canal length, therapeutic cerclage was performed, and bed rest was suggested n=6 . Emergency cerclage was performed on 2 patients with cervical opening n=2 . Age of the patients, weeks of pregnancy, gravidity, parity, body-mass index, and pregnancy outcome were recorded.Findings: The mean age of the patients was 28.5+4.5. Of the 41 patients who were applied cerclage in our study, 39 were singular and 2 were twin pregnancies. 33 patients were applied prophylactic, 6 were therapeutic and 2 were emergency cerclage operations. Of the 33 patients applied prophylactic cerclage; 18 patients gave birth at term 54.54% , 10 were preterm delivery, and 5 resulted in abortion. Both of the 2 patients with emergency cerclage had preterm delivery. Of the 6 therapeutic cerclage patients; 2 reached term, 4 had preterm delivery 2 were twin pregnancies .Conclusion: 54% of the patients who were applied prophylactic cerclage reached term.

Keywords:

Cervical cerclage, cervical insufficiency, trans-vaginal ultrasonography, pregnancy outcome,

PDF

___

Simcox R, Shennan A. Cervical cerclage: a review. Int J Surg.2007; 5: 205-2209.
Üner M, Trak B, Öner H. Servikal yetmezlik tanı ve tedavi prensipleri. Kadın Doğum Dergisi, 1986. 1/4, s: 229-232.
Riverrius L, Culpepp er N, Cole A: On barrenness, in: The Practice of Physic, Book 15.London, Peter Cole, 1659, p 502.
Rozenberg P, Gillet A, Ville Y. Transvaginal sonographic examination of the cervix in asymptomatic pregnant women: review of the literature. Ultrasound Obstet Gynecol. 2002; 19:441-456.
Rust OA, Roberts WE. Does cerclage prevent preterm birth? Obstet Gynecol Clin North Am. 2005; 32:441-456.
Berghella V, Odibo AO, Tolosa JE. Cerclagefor prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: a randomized trial. Am J Obstet Gynecol. 2004; 191:1311-1317.
Harger JH. Cerclage and cervical insufficiency: an evidence-based analysis. Obstet Gynecol. 2002; 100:1313-1327.
Final report of the Medical Research Council/Royal College of Obstetricians and Gynecologists multicentre randomized trial of cervical cerclage. MRC/RCOG Working Party on Cervical Cerclage.Br J Obstet Gynaeco.1993;100:516-523.
Berghella V, Seibel-Seamon J. Contemporary use of cervical cerclage. Clin Obstet Gynecol. 2007; 50:468-477.
Olatunbosun OA, al-Nuaim L, Turnell RW. Emergency cerclage compared with bed rest for advanced cervical dilatation in pregnancy. Int Surg. 1995;80:170-174.15.
Önalan GM, Kaya S, Yanık FF, Mülayım B, Zeyneloğlu HB. Acil Mc Donald serklaj uygulamaları: Olgu serisi literatürün gözden geçirilmesi. Turk Soc Obtet Gynecol. 2010 7:202-5.
Perrotin F, Marret H, Ayeva-Derman M, Alonso AM, Lansac J, Body G: [Second trimester cerclage of short cervixes: whichtechnique to use? A retrospective study of 25 cases]. J Gynecol Obstet Biol Reprod (Paris). 2002; 31:640-648.
Grimes D. Surgical Management of abortion.(In) Te Linde’s Operative Gynecology sixth ed. Philadelphia, J.B. Lippincott Company,1985, pp:51.