Tekrarlayan gebelik kaybı olgularında etiyoloji, demografik veriler ve takip eden gebeliklerdeki maternal ve fetal sonuçların retrospektif incelenmesi
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışma TGK nedeniyle Temmuz 2016-Aralık 2017 tarihleri arasında Kadın Hastalıkları ve Doğum Jinekoloji polikliniğimize başvuran ve etiyolojiye yönelik taramaları yapılan yaşları 21 ile 44 arasında değişen 100 olgu ile retrospektif olarak yapılmıştır. USG ya da histopatolojik olarak belgelenmiş en az 2 gebelik kaybı yaşayan olgular TGK kabul edilmiş, anatomik nedenlerle kayıp yaşayan olgular çalışma dışı bırakılmıştır. Olguların demografik verileri, ek hastalıkları, obstetrik öyküleri, kan grupları, sigara kullanımları, eşi ile akrabalık durumları sorgulandı. Karyotip analizi, herediter trombofili mutasyon analizleri (FVL, protrombin G20210A, MTHFR C677T, MTHFR A1298C, PAI), protein C, S, AT III, lupus antikoagülanı, antikardiyolipin antikor IgM ve IgG, antifosfolipid antikor IgM ve IgG, anti ?2 glikoprotein 1 IgM ve IgG ve varsa homosistein ve ANA tetkik sonuçları kaydedildi. Antikoagülan kullanımları sorgulandı. 100 olgunun etiyolojiye yönelik analizleri yapıldıktan sonra TGK sonrası doğum yapanlarla yapmayanlar karşılaştırıldı. Daha sonra doğum yapan olguların obstetrik sonuçları sorgulandı ve bu sonuçlar trombofili mutasyonları, tetkik sonuçları ve antikoagülan kullanımlarına göre değerlendirildi. Olguların %84'ünde herediter trombofili, %16'sında endokrin anormallik, %5 maternal ve %2,2 paternal kromozomal anormallik, %2'sinde immünolojik bozukluk saptandı. Trombofili mutasyon sıklığı özellikle de MTHFR mutasyonları anlamlı düzeyde yüksek saptandı. Diğer tetkikler ile ilgili önemli bir sonuca ulaşılmadı. Ek tetkiklerle araştırılan bir hastaya lupus bir hastaya AFAS tanısı koyuldu. TGK sonrası doğum yapanlarla yapmayanlar arasında demografik veriler ve tetkik sonuçları açısından fark izlenmedi. TGK sonrası doğum yapmada en etkili faktörün antikoagülan kullanımı olduğu tespit edildi. TGK sonrası doğum yapan 76 olgudan acil sezaryen endikasyonu gelişenlerde ya da erken doğum yapanlarda herediter trombofililerin sık olduğu görüldü. Özellikle erken doğum yapanlarda FVL+ PAI kombine heterozigotluğu anlamlı düzeyde yüksek saptandı ve MTHFR kombine heterozigotlarda da sezaryen doğum sıklığı anlamlı şekilde yüksekti. Kötü obstetrik sonuçları olan olgularda mutlaka bir herediter trombofili mutasyonu saptansa da perinatal komlikasyon sıklığını arttırdığı gösterilemedi. Antikoagülan kullanımının doğum yapmada etkili olduğu ancak gebelik sonuçları üzerine etki etmediği saptandı. Hatta perinatal komplikasyonları engelleyemediği görüldü. Anahtar kelimeler: TGK, trombofili, perinatal komplikasyon, antikoagülan
This study was carried out retrospectively with 100 cases aged between 21 and 44 who admitted to our Obstetrics and Gynecology outpatient clinic between July 2016 and December 2017 due to RPL and were screened for etiology. Cases with at least two pregnancy losses documented by USG or histopathology were accepted as RPL, and cases with loss due to anatomical reasons were excluded from the study. Demographic data, comorbidities, obstetric histories, blood groups, smoking and consanguinity status of the cases were questioned. Karyotype analysis, hereditary thrombophilia mutation assays (FVL, prothrombin G20210A, MTHFR C677T, MTHFR A1298C, PAI), protein C, S, AT III, lupus anticoagulant, anticardiolipin antibody IgM and IgG, antiphospholipid antibody IgM and IgG, anti ?2 glycoprotein 1 IgM and IgG and, if any, homocysteine and ANA results were recorded. Use of anticoagulant was questioned. After analyzing the etiology of 100 cases, those who gave birth after RPL and those who did not were compared. Then, the obstetric results of the cases who gave birth were questioned and these results were evaluated according to thrombophilia mutations, test results and anticoagulant use. Hereditary thrombophilia was found in 84% of the cases, endocrine abnormality in 16%, maternal and paternal chromosomal abnormalities in 5%, and immunological disorders in 2%. The frequency of thrombophilia mutations, especially MTHFR mutations, was found to be significantly higher. No significant results were obtained regarding the other parameters. One patient was diagnosed with lupus and one patient was diagnosed with APAS. There was no difference between the patients who gave birth after RPL and the patients who did not in terms of demographic data and test results. It was concluded that the most effective factor in giving birth after RPL was the use of anticoagulants. It was observed that hereditary thrombophilias were common in cases who had an emergency cesarean section indication out of 76 cases who gave birth after RPL or those who gave birth prematurely. FVL+PAI combined heterozygosity was found to be significantly higher especially, in cases who delivered prematurely, and the frequency of cesarean section was also significantly higher in MTHFR combined heterozygotes. Although a hereditary thrombophilia mutation was definitely detected in cases with poor obstetric outcomes, it could not be shown to increase the frequency of perinatal complications. It was concluded that the use of anticoagulants was effective in giving birth, but did not affect pregnancy outcomes. It was even seen that it could not prevent perinatal complications. Keywords: RPL, thrombophilia, perinatal complication, anticoagulant
This study was carried out retrospectively with 100 cases aged between 21 and 44 who admitted to our Obstetrics and Gynecology outpatient clinic between July 2016 and December 2017 due to RPL and were screened for etiology. Cases with at least two pregnancy losses documented by USG or histopathology were accepted as RPL, and cases with loss due to anatomical reasons were excluded from the study. Demographic data, comorbidities, obstetric histories, blood groups, smoking and consanguinity status of the cases were questioned. Karyotype analysis, hereditary thrombophilia mutation assays (FVL, prothrombin G20210A, MTHFR C677T, MTHFR A1298C, PAI), protein C, S, AT III, lupus anticoagulant, anticardiolipin antibody IgM and IgG, antiphospholipid antibody IgM and IgG, anti ?2 glycoprotein 1 IgM and IgG and, if any, homocysteine and ANA results were recorded. Use of anticoagulant was questioned. After analyzing the etiology of 100 cases, those who gave birth after RPL and those who did not were compared. Then, the obstetric results of the cases who gave birth were questioned and these results were evaluated according to thrombophilia mutations, test results and anticoagulant use. Hereditary thrombophilia was found in 84% of the cases, endocrine abnormality in 16%, maternal and paternal chromosomal abnormalities in 5%, and immunological disorders in 2%. The frequency of thrombophilia mutations, especially MTHFR mutations, was found to be significantly higher. No significant results were obtained regarding the other parameters. One patient was diagnosed with lupus and one patient was diagnosed with APAS. There was no difference between the patients who gave birth after RPL and the patients who did not in terms of demographic data and test results. It was concluded that the most effective factor in giving birth after RPL was the use of anticoagulants. It was observed that hereditary thrombophilias were common in cases who had an emergency cesarean section indication out of 76 cases who gave birth after RPL or those who gave birth prematurely. FVL+PAI combined heterozygosity was found to be significantly higher especially, in cases who delivered prematurely, and the frequency of cesarean section was also significantly higher in MTHFR combined heterozygotes. Although a hereditary thrombophilia mutation was definitely detected in cases with poor obstetric outcomes, it could not be shown to increase the frequency of perinatal complications. It was concluded that the use of anticoagulants was effective in giving birth, but did not affect pregnancy outcomes. It was even seen that it could not prevent perinatal complications. Keywords: RPL, thrombophilia, perinatal complication, anticoagulant
Açıklama
Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Anahtar Kelimeler
Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology
