Profilaktik Serklaj ve Acil Serklaj Operasyonlarının Perinatal Sonuçlarının Karşılaştırılması: 10 Yıllık Deneyim

Amaç: Preterm doğumu önlemek amacıyla servikal yetmezlik saptanıp proflaktik serklaj ve acil serklaj operasyonu yapılmış olan olguların perinatal sonuçlarını karşılaştırmak. Gereçler ve Yöntem: Ocak 2009 - Ocak 2019 arasında Bülent Ecevit Üniversitesi, Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde serklaj yapılmış olan hastaların medikal bilgileri retrospektif olarak incelendi. Servikal yetmezlik ile ilişkili bir veya daha fazla ikinci trimester gebelik kaybı hikayesi bulunan ya da servikal yetmezlik nedeniyle daha önce serklaj yapılmış olan hastalar proflaktik serklaj grubu olarak, ikinci trimesterde ağrısız servikal dilatasyon ve/veya membranların vajene prolabe olduğu saptanarak serklaj yapılan olgular ise acil serklaj grubu olarak ayrıldı. Gruplar arasında gebelik süresince gelişen komplikasyonlar, perinatal sonuçlar ve inflamatuar belirteçlerden lökosit (WBC), periferik kan nötrofil-lenfosit oranı (NLR) ve trombosit - lenfosit oranı (PLR) karşılaştırıldı. Bulgular: Yirmi yedi olgudan oluşan proflaktik serklaj grubunda canlı doğum oranı %96,6 iken, 16 olgudan oluşan acil serklaj grubunda canlı doğum oranı yine oldukça yüksek bir oran olan %81,3 olarak saptandı. Proflaktik serklaj ve acil serklaj yapılan hastaların canlı doğum oranı, doğum haftası, preterm doğum oranı ve doğum kilosu her iki grupta da benzerdi (p=0,137; p=0,179; p= 0,085; p=0,602). Acil serklaj yapılan olguların servikal dilatasyonları 1-4 cm arasında değişmekteydi. Beş olguda servikal dilatasyon ≥3 cm ve membranlar prolabe idi, bu olguların sadece biri (%20) canlı term doğumla sonuçlandı. Acil serklaj grubunda lökosit (WBC) sayısı proflaktik serklaj grubundan daha yüksek bulundu (p=0,037). Buna karşılık NLR, PLR, nötrofil, lenfosit ve trombosit sayıları ise her iki grupta farksız saptandı. Tüm olgular içinde preterm doğumlar ile term doğumlar arasında yapılan karşılaştırmada ise WBC, NLR ve PLR değerleri açısından fark saptanmadı. Sonuç: Acil serklaj operasyonunun perinatal sonuçları proflaktik serklaj operasyonu ile benzer ve her iki grupta da canlı doğum ve term doğum oranları yüksek saptanmıştır. Bununla beraber acil serklaj yapılan grupta servikal dilatasyonun ≥3 cm olduğu olgularda ise neonatal mortalite, abortus ve preterm prematür membrane rüptürü oranı yüksektir. Bu bulgular özellikle acil serklaj yapılacak hastaların seçiminde dikkatli olmak gerektiğini göstermektedir.

Comparison of Perinatal Outcomes of Prophylactic and Emergency Cerclage: Ten Years of Experience

Objective: To compare perinatal outcomes of prophylactic cerclage and emergency cerclage operations in patients with cervical insufficiency to prevent preterm birth. Material and Methods: A retrospective study was conducted between June 2009 and June 2019 in University of Bulent Ecevit, Obstetrics and Gynecology Department. All medical records were evaluated. Patients with history of one or more second-trimester pregnancy losses related to painless cervical dilation and in the absence of labor or abruptio placentae or history of prior cerclage due to painless cervical dilation in the second trimester were included to prophylactic cerclage group and patients with painless cervical dilation and/or prolabed membranes at physical examination in the second trimester were included to emergency cerclage group. Pregnancy complications, perinatal outcomes and inflammatory markers such as WBC count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) were assessed. Results: Live birth rate were 96,6% in prophylactic cerclage group which was consisted of 27 patients and 81,3% in emergency cerclage group which was consisted of 16 patients. Similarity were observed in comparison of live birth rate, gestational age at birth, preterm birth rates and birthweight between both groups (p=0,137; p=0,179; p= 0,085; p=0,602). Cervical dilatation was between 1 and 4 cm in emergency cerclage group. Cervical dilatation were ≥3 cm and membranes were prolabed in 5 patients. Only one of five patient’s pregnancy was resulted with term birth. WBC count were higher in emergency cerclage group than prophylactic cerclage group (p=0,037). On the contrary, no difference was seen in comparison of NLR, PLR, neutrophil, lymphocyte, and platelet count between groups. Likewise, WBC, NLR and PLR were not different between the patients who were delivered preterm and term in all groups. Conclusion: Our study suggests that, both prophylactic cerclage and emergency cerclage increases the live birth and term birth rates. However increased neonatal mortality, abortus and preterm premature membrane rupture rates were observed in patients with cervical dilatation ≥3 cm. Patients must be evaluated carefully before emergency cerclage operation.

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Zeynep Kamil Tıp Bülteni-Cover
  • ISSN: 1300-7971
  • Başlangıç: 1969
  • Yayıncı: Ali Cangül
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