Fatih BAKIR, H. Tuğrul ÇELİK, Özhan ÖZDEMİR, M. Metin YILDIRIMKAYA

Maternal Kanda Afp, Hcg Ve Ankonjuge Östriol Düzeylerinin Gebelik Komplikasyonları İle İlişkisi

Amaç: Bu çalışmada Ankara İli ve çevresindeki gebe populasyonunda, maternal kanda yüksek AFP, yüksek hCG, düşük AFP ve düşük ankonjuge östriol değerleri ile gebelik komplikasyonları arasındaki ilişkinin araştırılması amaçlanmıştır. Yöntem: Sağlık Bakanlığı, Ankara Numune Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği’nde üçlü tarama testi yapılan 951 hastanın, gebelik sırasındaki komplikasyon oranları retrospektif olarak incelenmiştir. Her gebeden venöz kan örneği alınarak hCG, uE3 ve AFP testleri Ankara Numune Hastanesi One cihazında kompetetif immunoassay yöntemi kullanılarak ölçülmüştür. Elde edilen sonuçlar lisanslı PRISCA programı kullanılarak, gebelik haftalarına göre daha önceden belirlenen düzeltilmiş ortancanın katları multiple of median: MoM değeri olarak rapor edilmiştir. Hastanın yaşı, ırkı, kilosu, sigara ve diyabet öyküsü, IVF gebelik, örnek alınma tarihi, ultrasonografi tarihindeki BPD bi-parietal diameter ölçümü veya son adet tarihine göre risk hesabı yapılmıştır. Maternal kanda yüksek AFP >2 MoM , yüksek HCG >2 MoM , düşük AFP 2 MoM , 21’inde düşük AFP

Anahtar Kelimeler:

Gebelik Komplikasyonları, AFP, hCG, Ankonjüge UE3

The Relationship Between Pregnancy Complications And Afp, Hcg And Unconjuge Estriol Level In Maternal Serum

Objective: The aim of the study was to determine the relationship of pregnancy complications with high low AFP, high HCG and low estriol levels detected in maternal serum in the Ankara regions pregnancy population. Method: 951 patients who had undergone triple test during pregnancy for complication rates at T.C.S.B. Ankara Numune Education and Research Hospital were determined retrospectively. Venous blood samples were taken from each patient, Beta hCG, uE3 and AFP tests performed at Ankara Numune Hospital Biochemistry laboratory by using Immulite One® system which was based competetive immunassay methods. Obtained results reported corrected multiple of the median median multiple of: MoM values according to pregnancy weeks by using licenced computer program Prisca® . The risk calculation was made by Patient’s age, race, weight, smoking and diabetes, history of IVF pregnancies and sampling date, using either BPD biparietal diameter measurement at ultrasound date or last menstrual period.The patients with high AFP levels >2 MoM , high HCG levels >2 MoM , low AFP levels 2 MoM , 21 patients with low AFP

Keywords:

Pregnancy Complications, AFP, hCG, Unconjuge Estriol,

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1. Ogilvie CM. Prenatal diagnosis for chromosome abnormalities: Past, present, future. Pathol Biol. 2003;51: 156- 60.
2. Carl A. Burtis, Edward R. Ashwood, and David E. Burns. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, Fourth Edition, St. Louis, MO, Elsevier Saunders, 2006: 2167-86
3. Simpson JL, Elias S. Pre-natal diagnosis of genetic disorders. In: Creasy, R.K. Creasy and Resnik's maternal-fetal medicine: principles and practice, 4th edition, Philadelphia, PA, Saunders/Elsevier, 2004: 61-88
4. Cuckle H. Time for total shift to first trimester Down’s screening. Lancet, 2001;358: 1658–9.
5. Evans, Mark I, et al. Alpha-fetoprotein and biochemical screening. Reproductive Risks and Prenatal Diagnosis: Norwalk, Appleton & Lange, 1992: 233-5.
6. Crandall BF, Robınson, Grau P. Risks associated with an elevated maternal serum alpha-fetoprotein. Am J Obstet Gynecol, 1991; 165: 58-6.
7. Dungan JS, Shulman LP, Philips OP, et al. Positive serum screening for fetal Down syndrome does not predict adverse pregnancy outcome in absence of fetal aneuploidy. J Soc Gynecol Invest, 1994; 1: 55-8.
8. Hsieh TT, Hung TH, Hsu JJ, et al. Prediction of adverse perinatal outcome by maternal serum screening for Down syndrome in an Asian population. Obstet Gynecol, 1997; 89: 937-40.
9. Spencer K. Aneuploidy screening in the first trimester. Am J Med Genet Part C Semin Med Genet, 2007; 145C: 18-32.
10. Saller Jr, Devereux N, Jacob A. Canıck. Current methods of prenatal screening for Down syndrome and other fetal abnormalities. Clinical obstetrics and gynecology, 2008; 51(1): 24-36.
11. Gerald J. Mizejewski. Physiology of AlphaFetoprotein as a Biomarker for Perinatal Distress: Relevance to Adverse Pregnancy Outcome. Experimental Biology and Medicine, September 2007: 232: 993-1004
12. Walton DL, Norem CT, Schoen EJ, Ray GT, Colby CJ. Second-trimester serum chorionic gonadotropin concentrations and complications and outcome of pregnancy. N Engl J Med, 1999; 341: 2033–8.
13. Seppala M, Rouslahti E. Alpha-fetoprotein in Rhimmunized pregnancies. Obstet Gynecol,1973; 42(5):637-794
14. Lieppman RE, Williams MA, Cheng EY, et al. An association between elevated levels of human chorionic gonadotropin in the midtrimester and adverse pregnancy outcome. Am J Obstet Gynecol, 1993; 168: 1852-7.
15. Pergament E, Stein AK, Fiddler M, Kupferminc MJ. Adverse pregnancy outcome after a false positive screen for Down Syndrome using multiple markers. Obstet Gynecol, 1995: 86: 255-8.
16. Yaron Y, Cherry M, Kramer RL, et al. Secon-trimester maternal serum marker screening: Maternal serum a-fetoprotein, human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome. Am J Obstet Gynecol, 1999; 181: 968-74.
17. Haddow JE. Prenatal screening for open neural tube defects, Down’s Syndrome and other major fetal disorders. Semin Perinatol, 1990; 14: 488-503
18. Smith GC, Shah I, White IR, Pell JP, Crossley JA, Dobbie R. Maternal and biochemical predictors of antepartum stillbirth among nulliparous women in relation to gestational age of fetal death. BJOG. 2007; 114: 705-14.
19. Say B. Türk halkında çeşitli konjenital malformasynların görülme sıklığı. Tez, Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü, 1969
20. Atasü T, Kösebay D, Palandöken N. Anensefal cocuk ve doğum. Cerrahpaşa Tıp Fak Mec, 1973; 4 : 36