İntrauterin gelişme geriliği saptanan gebelerde perinatal morbidite ve mortalitenin öngörülmesinde fetal aortik istmus doppler akımlarının rolü
Küçük Resim Yok
Tarih
2011
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: İntrauterin gelişme geriliği saptanan fetüslerde perinatal sonuçların (mortalite ve morbidite) öngörülmesinde aortik istmus (Aoİ) doppler akımlarının rolünü değerlendirmektir.Materyal ve metod: 24-37 gebelik haftası arasında olan anormal umblikal arter (UA) doppler indeksleri olup intrauterin gelişme geriliği (İUGG) ön tanısı ile kliniğimize yatırılarak doğum yapan 30 hasta prospektif olarak değerlendirildi. Aoİ impedens indeksleri ( Pİ ve Rİ ) ve mutlak velositeler ( EDV, PSV ve TAMXV) tüm hastalarda ölçüldü ve gebelik haftasına uygun referans aralıklar ile karşılaştırıldı. Ayrıca ; doğum zamanı Aoİ segmentindeki net diyastolik akımın yönünü belirlemek için S + D / S formülü ile hesaplanan istmik flow indeks (İFİ) 'i kullanarak hastalar Aoİ antegrad akım ( İFİ ? 1, n:11) ve Aoİ retrograd akım ( İFİ < 1, n:19 ) olarak iki gruba ayrıldı. Hastaların klinik gözlemi; gestasyonel yaş, fetal biyofizik profili ve UA, orta serebral arter (MCA) ve duktus venozus (DV) doppler incelemelerinin sonuçlarına göre yürütüldü. Aoİ doppler parametrelerinin bozulma zamanını belirlemek için de 12 hastada doğumdan önceki 30 günlük sürede belirli aralıklarla seri UA, MCA, Aoİ ve DV doppler incelemeleri yapıldı ve bu parametrelerdeki longitudinal değişimleri regresyon çizgilerine dönüştürüldü. Kötü perinatal sonuçlar; intrauterin ölüm, neonatal ölüm, respiratuar distress sendromu (RDS), bronkopulmoner displazi ( BPD), grade III-IV intravenriküler hemoraji (İVH), nekrotizan enterokolit (NEC) ve neonatal sepsisi olarak tanımlandı.Bulgular: Aoİ retrograd akım ile kötü perinatal sonuçlar arasında anlamlı korelasyon saptandı, perinatal total mortalite ve morbidite oranları Aoİ antegrad akım grubuna göre Aoİ retrograd grupta yüksek bulundu ( sırası ile 36.8% vs.0%, P < 0.029 ve 47.4% vs 9.1 %, P <0.049 ). 12 hastada yapılan longitudinal incelemede; Aoİ doppler parametrelerinin UA ve MCA doppler parametrelerinin bozulmasından ortalama 20 gün önce ve DV doppler parametrelerinin bozulmasından 3-7 gün önce anormal hale geldiği saptandı.Sonuç: İntrauterin gelişme geriliği olan fetüslerde Aortik istmus retrograd akım ile kötü perinatal sonuçlar arasında güçlü korelasyon mevcut. Bulgularımız; intrauterin gelişme geriliği olan fetüslerin klinik gözleminde Aortik istmus doppler çalışmalarının potansiyel rolünü göstermektedir
Objectives: To evaluate the characteristics and association with perinatal outcome of the aortic isthmus (AoI) circulation as assessed by Doppler imaging in preterm growth-restricted fetuses.Material and Methods : Thirty fetuses with intrauterine growth restriction (IUGR) and abnormal umbilical artery (UA) Doppler parameters were prospectively examined at 24?37 weeks? gestation. AoI impedance indices (PI and resistance index) and absolute velocities (peak systolic (PSV), end-diastolic and time-averaged maximum (TAMXV) velocities), were measured in all cases and compared with reference ranges by gestational age. Furthermore, before delivery fetuses were stratified into two groups according to the direction of the diastolic blood flow in the AoI measured using isthmic flow index (İFİ=D+S /S) : those with antegrade flow (İFİ ?1, n =11) and those with retrograde flow (İFİ <1, n =19). Clinical surveillance was based on gestational age, fetal biophysical profile and Doppler assessment of the UA, middle cerebral artery and ductus venosus (DV). İn order to estimate the mean time point at which Aoİ Doppler parameters became abnormal ; umbilical and middle cerebral arteries, ductus venosus and aortic isthmus were explored serially by means of pulsed Doppler in 12 growth restricted fetuses and longitudinal changes in the last 30 days before delivery were modeled by multilevel analysis. Adverse perinatal outcome was defined as stillbirth, neonatal death and severe morbidity (respiratory distress syndrome, bronchopulmonary dysplasia, Grade III/IV intraventricular hemorrhage, necrotizing enterocolitis and neonatal sepsis).Results: A significant correlation was found between retrograde blood flow in the AoI and adverse perinatal outcome, the overall perinatal mortality and morbidity being higher in the retrograde group (36.8% vs.0%, P < 0.029 and 47.4% vs 9.1 %,P <0.049 respectively). A longitudinal study of 12 preterm growth restricted fetuses showed abnormal AoI blood flow on average 20 days after UA/MCA Doppler abnormalities and 3-7 days before the DV blood flow changes.Conclusions: Retrograde flow in the AoI in growth restricted fetuses correlates strongly with adverse perinatal outcome. Our findings suggest a potential role for Doppler imaging of the AoI in the clinical surveillance of fetuses with IUGR.
Objectives: To evaluate the characteristics and association with perinatal outcome of the aortic isthmus (AoI) circulation as assessed by Doppler imaging in preterm growth-restricted fetuses.Material and Methods : Thirty fetuses with intrauterine growth restriction (IUGR) and abnormal umbilical artery (UA) Doppler parameters were prospectively examined at 24?37 weeks? gestation. AoI impedance indices (PI and resistance index) and absolute velocities (peak systolic (PSV), end-diastolic and time-averaged maximum (TAMXV) velocities), were measured in all cases and compared with reference ranges by gestational age. Furthermore, before delivery fetuses were stratified into two groups according to the direction of the diastolic blood flow in the AoI measured using isthmic flow index (İFİ=D+S /S) : those with antegrade flow (İFİ ?1, n =11) and those with retrograde flow (İFİ <1, n =19). Clinical surveillance was based on gestational age, fetal biophysical profile and Doppler assessment of the UA, middle cerebral artery and ductus venosus (DV). İn order to estimate the mean time point at which Aoİ Doppler parameters became abnormal ; umbilical and middle cerebral arteries, ductus venosus and aortic isthmus were explored serially by means of pulsed Doppler in 12 growth restricted fetuses and longitudinal changes in the last 30 days before delivery were modeled by multilevel analysis. Adverse perinatal outcome was defined as stillbirth, neonatal death and severe morbidity (respiratory distress syndrome, bronchopulmonary dysplasia, Grade III/IV intraventricular hemorrhage, necrotizing enterocolitis and neonatal sepsis).Results: A significant correlation was found between retrograde blood flow in the AoI and adverse perinatal outcome, the overall perinatal mortality and morbidity being higher in the retrograde group (36.8% vs.0%, P < 0.029 and 47.4% vs 9.1 %,P <0.049 respectively). A longitudinal study of 12 preterm growth restricted fetuses showed abnormal AoI blood flow on average 20 days after UA/MCA Doppler abnormalities and 3-7 days before the DV blood flow changes.Conclusions: Retrograde flow in the AoI in growth restricted fetuses correlates strongly with adverse perinatal outcome. Our findings suggest a potential role for Doppler imaging of the AoI in the clinical surveillance of fetuses with IUGR.
Açıklama
Anahtar Kelimeler
Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology, Bebek ölümleri, Infant mortality, Fetal gelişme geriliği, Fetal growth retardation, Fetüs, Fetus, Gebelik, Pregnancy, Perinatoloji, Perinatology, Plasenta, Placenta, Plasenta fonksiyon testleri, Placental function tests, Ultrasonik dalgalar, Ultrasonic waves, Ultrasonografi-doppler, Ultrasonography-doppler
