Primigravid Pre-Eklamptik Olguların ... - Yeni Tıp Dergisi

-135
Orijinal makale
Primigravid Pre-
ÖZET
Amaç:
-
Materyel ve Metot:
-
-
tir.
Bulgular: dilen primigravid preeklamptik
gebelerin %30,8’i hafif preeklampsi grubuna
(Grup 1), %69,2’si
2) dahil edildi. H-41) idi ve
her iki grupta da benzerdi (p:0,3
gebelik öncesi vücut kitle indeksi ve gebelik süresince
(p:0,72 ve
ryen ile
-
-
-
Sonuç: Maternal ve neonatal komplik-
-
geçirilmelidir. K-
.
Anahtar Kelimeler: Preeklampsi; neonatal morbidite;
preekla
ABSTRACT
Epidemiologic investigation of primigravid preeclamptic
patients
Aim: The aim of this study is to define and evaluate the
potential risk factors to be investigated in terms of the
severity of preeclampsia in primigravid patients.
Material and Method: Four hundred and fifty preeclamptic
primigravid pregnant women admitted to the
Dr. Zekai Tahir Burak Women Health Research and
Education Hospital, Perinatology Clinic were included in
to the study between January 1, 2003 and November
31, 2007. All the demographic values and laboratory
results were investigated retrospectively.
Results: Most of the primigravid preeclamptic patients
(69.2%) were included into Group 2 (severe preeclempsia),
whereas 30,8% of them into Group 1 (mild
preeclampsia). The mean age of the patients was 24
(16-41) years old, and similar between both of the
groups (p:0,30). The mean of body mass indexes of the
pre-pregnancy period and the weight gaining during the
pregnancy were similar in both groups (p:0,72 and p:
0,36, respectively). The presences of smoking and
regular antenatal visits were not related with the
severity of preeclampsia. The diagnosis was established
earlier gestational week in severe preeclampsia than the
mild one, and the main route of delivery was cesarean
section in severe preeclampsia. Neonatal morbidities and
mortalities were all higher in Group 2. Forty-one percent
of the patients did not have any symptoms during the
first admission of the hospital, the routine investigations
revealed the diagnosis of preeclampsia mostly.
Hemoconcentration was mainly seen in severe
preeclampsia, and liver enzyme dysfunction was also
common in the same group.
Conclusion: In order to prevent maternal and neonatal
complications, the early diagnosis of preeclampsia is
mandatory. To determine the incidence and possible risk
factors of preeclampsia environmental conditions and
circumstances should be investigated periodically. With
the increasing city life and maternal age of planned
pregnancy due to participating of women in daily
working life, preeclampsia may be thought as emerging
problem in the near future.
Key Words: Preeclampsia; neonatal morbidity; severity
of preeclampsia
G
Preeklampsi, tüm dünyada hem maternal hem de
perinatal mortalite ve morbiditenin önde gelen
e-mail: drsibela@yahoo.com.tr
: 16.07.2012
: 15.08.2012
sebeplerinden birisidir 1 . Dünya genelinde tüm
gebeliklerin ortalama %3,1’nin preeklampsi ile
-
kt tedir
2-4
131

-
lirken, Lawler ve ark.’
77,
5,6
-
7 .
Türkiye’de Büyükören ve ark.’
8 .
Preeklampsi için risk faktörl -
1,2,6
ailede hipertansiyon,
k lupus gibi otoim-
-
hidrops fetalis, kötü kontrollü diyabet, mol hidatiform,
pozitif kardiolipin testi, genetik faktörler,
-
olmazsa paritenin koruyucu etkisi ortadan kalkar 9 .
preeklampsi g 2,10 .
-
istenPreeklampsi
öyküsü, sadece bir sonraki gebelikte preeklampsi
a ileride ortaya
11 .
bunda
gösterilen primigravid preeklamptik gebe-
MATERYAL VE METOT
1 Ocak 2003 -
K’nde yatarak
ted313 idi.
-
primigravid hasta dahil edildi. Kronik hipertansi-
-
l edilen 445 hasta, klinik ve labora-
olarak iki alt grupta incelendi. Gruplardan elde
edilen veriler birbirleri ve literatür ile benzerlikler
ç
protei 300 mg
tüm bilgiler, protokol defterleri ve ar
-küretaj öyküsü,
ultrasonografi (USG) ve son adet tarihine (SAT)
-sigara kul k
bejen, glukoz, kara-
siyon testleri (AST, ALT), laktat dehidrogenaz
(LDH), total protein, albumin, böbrek fonksiyon
testleri (üre, kreatinin), bilirubin,
ekli,
APGAR skoru (1. ve 5. dakikadaki) not edildi.
(Sistolik TA + (Diastolik TA
x2)/
afif hipertansiyon,
hipertansiyon olarak kabul edildi.
A
üri (5 gr/24 saat)
üri (500 ml/24 saat)
üel bulgular
n en az
3 )
based stati
-Kare
-
Whi
nicel veriler için aritmetik ortalama +/- standart
BULGULAR
eek-
8) hafif preeklampsi
(Grup 1), 308’i (% 69,
-
-41) olarak tespit edildi.
132

’i
%kati
-
%6,3’ünün (n:
2 unun (n:82)
26-35 kg/m 2 ve sadece %4,9’unun (n:23) >35 kg/m 2
o0,72) (Tablo 1). Gebelik es-
a her iki grupta benzer idi
(p:0,36).
-
01)
-
-
sahip olan gebelerin %40,3’ü (n: 242) hafif
preeklampsi grubunda idi (p

Tablo 2. Preeklampsi iddetine Göre HLaboratuar
Hafif Preeklampsi
(N: 137)
(N: 308)
Hemoglobin (gr/dl) , ort. +/- SD 11,8 +/-1,9 12,7+/-1,7

n
3-5 . Özdemir ve ark., bizim
-
iken
16 .
Prematü
-
ta
9,10 .
-
-
bu
-
mektedir
41’inde
al takibin önemini göstermektedir.
Waugh ve ark.
17
(%87,4)
-
-
-
-
18
e
ürde de trombo-
ek-
18 .
eratürde orta serebral ve
uterin laroluyla preek-
19 .
Sonuç olarak -
-
hem anne hem de bebek
-
-
-
20 . Bu sayede, literatürde yer alan
-
21,22 .
REFERANSLAR
1. Mustafa R, Ahmed S, Gupta A, Venuto RC. A comprehensive
review of hypertension in pregnancy. J Pregnancy 2012;2012:105918. Epub
2012 May 23.
2. Melamed N, Hadar E, Peled Y, Hod M, Wiznitzer A, Yogev Y. Risk
for recurrence of preeclampsia and outcome of subsequent pregnancy in
women with preeclampsia in their first pregnancy. J Matern Fetal Neonatal
Med 2012 May 16. [Epub ahead of print].
3. Erden AC, Yayla M. Preeklampsi ve eklampside maternal fetal
morbidite mortalite. Perinatoloji 1993;1:24-30.
4. Akar ME, Eyi EG, Yilmaz ES, Yuksel B, Yilmaz Z. Maternal deaths
and their causes in Ankara, Turkey, 1982-2001. J Health Popul Nutr 2004;
22(4):420-8.
5. Zhang J, Meikle S, Trumble A. Severe maternal morbidity
associated hypertensive disorders in pregnancy in United states. Hypertens
Pregnancy 2003;22:203-12.
6. Lowler J, Osman M. Population-based analysis of hypertensive
disorders in pregnancy. Hypertension in pregnancy 2007;26:67-76.
7. Ventura SJ, Martin JA, Cutin SC, Abma JC, Henshaw W. Births:
Final data for 1999. National Vital Satistics Reports 2001;49:1-100.
8. Buyukoren A, Turfanda A. Gebelik toksikozu görü
tesi Dergisi 1992;23:581-5.
9. Skjaerven RS, Wilcox AJ, Lie RT. The interval between pregnancies
and the risk of preeclampsia. N Engl J Med 2002;346:33-38.
10. Odegård RA, Vatten LJ, Nilsen ST, Salvesen KA, Austgulen R.
Preeclampsia and fetal growth. Obstet Gynecol 2000;96(6):950-5.
11. Aukes A, De Groot J, Wiegman M, Aarnoudse J, Sanwikarja G,
Zeeman G. Long-term cerebral imaging after pre-eclampsia. BJOG 2012;
119(9):1117-22.
12.
Retrospektif Analizi. T Klin Obstet 2002;12:38-42.
13. Augistin Conde-Agudelo, Jose MB. Risk factors for preeclempsia in
a large cohort of Latin American and Caribbean Women. British Journal
Obstet & Gynecology 2000;107:75-82.
14. Martin LC, Hall MH, Campbell DM. The effect of smoking on
preeclamsia in twin pregnancy. British Journal of Obstetrics and Gynecology
2000;107:745-49.
15. Salihu HM, De La Cruz C, Rahman S, August EM. Does maternal
obesity cause preeclampsia A systematic review of the evidence. Minerva
Ginecol 2012;64(4):259-80.
16.
sendromunda maternal morbidite ve mor
Fakültesi Dergisi 2003;3:5-9.
17. Waugh J, Perry IJ, Halligan AW, De Swiet M, Lambert PC, Penny
JA, et al. Birth weight and 24-hour ambulatory blood pressure in
nonproteinuric hypertensive pregnancy. Am J Obstet Gynecol 2000;183(3):
633-7.
18. Calvert SM, Tuffnell DJ, Haley J. Poor predictive value of platelet
count, mean platelet volume and serum urate in hypertension in pregnancy.
Eur J Obstet Gynecol Reprod Biol 1996;64:2:179-184.
19. Jodicke C, Maulik D, Singh P, Heitmann E, Maulik D. Role of
ultrasound in pre-eclampsia. Minerva Ginecol 2012;64(4):293-308.
20. Forest JC, Charland M, Massé J, Bujold E, Rousseau F, Lafond J, et
al. Candidate biochemical markers for screening of pre-eclampsia in early
pregnancy. Clin Chem Lab Med 2012;1;50(6):973-84.
21. Roberge S, Giguère Y, Villa P, Nicolaides K, Vainio M, Forest JC, et
al. Early Administration of Low-Dose Aspirin for the Prevention of Severe
and Mild Preeclampsia: A Systematic Review and Meta-Analysis. Am J
Perinatol 2012 Apr 11. [Epub ahead of print]
22. Kasawara KT, Nascimento SL, Costa ML, Surita FG, E Silva JL.
Exercise and physical activity in the prevention of preeclampsia: systematic
review. Acta Obstet Gynecol Scand 2012;22(2):189-94.
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