Tekrarlayan Gebelik Kaybı
9. Alloimmün Faktörler
İnsan lökosit antijeni (HLA) tiplendirmesi, embriyo-toksik faktörler, desidual sitokin profilleri, bloke edici veya antipaternal antikor seviyeleri, HLA-G polimor-fizmi ve diğer immünolojik özellik ve faktörler
üze-BÖLÜM 7 • Tekrarlayan Gebelik Kaybı 41
4. Kolte AM, van Oppenraaij RH, Quenby S, Farquharson RG, Stephenson M, Goddijn M, Christiansen OB; ESHRE Special Interest Group Early Pregnancy.. Non-visualized pregnancy losses are prognostically important for unexplained recurrent miscarriage. Hum Reprod. 2014;29:931-7.
5. Stirrat GM. Recurrent miscarriage. Lancet 1990;336:673–5.
6. Nybo Anderson AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linka-ge study. BMJ 2000;320:1708–12.
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10. Cliff ord K, Rai R, Regan L. Future pregnancy outcome in unexplained recurrent first trimester miscarriage. Hum Reprod 1997;12:387–9.
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2016;31:2428-2434.
12. Practice Committee of the American Society for Reproductive Medicine.. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012;98:1103-11.
13. Christiansen OB, Nybo Andersen AM, Bosch E, Daya S, Del-ves PJ, Hviid TV, Kutteh WH, Laird SM, Li TC, van der Ven K. Evidence-based investigations and treatments of recurrent pregnancy loss. Fertil Steril. 2005 ;83:821-39.
14. Stephenson MD, Kutteh W. Evaluation and management of re-current early pregnancy loss. Clin Obstet Gynecol 2007;50:132–
45.
15. Rai R, Regan L. Recurrent miscarriage. Lancet 2006;368:601–
11.
16. Stephenson MD, Awartani KA, Robinson WP. Cytogenetic analysis of miscarriages from couples with recurrent miscarria-ge: a case-control study. Hum Reprod 2002;17:446–51.
17. Ogasawara M, Aoki K, Okada S, Suzumori K. Embryonic kar-yotype of abortuses in relation to the number of previous mis-carriages. Fertil Steril 2000;73:300–4.
18. Franssen MTM, Musters AM, van der Veen F, Repping S, Lesc-hot NJ, et al. Reproductive outcome aft er PGD in couples with recurrent miscarriage carrying a structural chromosome abnor-mality: a systematic review. Hum Reprod Update 2011;17:467–
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Uygulama Önerileri
Açıklanamayan TGK için kanıta dayalı olarak te-davi bulunmamaktadır.
Ampirik tedavilerin seçiminde; düşük riskliden yüksek riskliye, basitten komplikeye, daha uy-gun fi yatlıdan daha pahalı tedavi seçenekler-ine yönelmek sağduyulu olacaktır.
- Düşüklerin büyük çoğunluğu sporadiktir ve anne yaşından büyük oranda etkilenen genetik ne-denlere bağlı oldukları düşünülmektedir.
- TGK iki veya daha fazla başarısız klinik gebelik olarak tanımlanır.
- TGK olgularının %50’sine yakınında belirgin bir etyoloji bulunamamaktadır.
SONUÇ
- Düşüklerin büyük çoğunluğu sporadiktir ve anne yaşından büyük oranda etkilenen genetik ne-denlere bağlı oldukları düşünülmektedir.
- TGK iki veya daha fazla başarısız klinik gebelik olarak tanımlanır.
- TGK araştırmasına iki klinik gebelik kaybından sonra (İVF gebeliklerinde biyokimyasal gebelikler de dahil) başlanmalıdır.
- TGK olgularının %50’sine yakınında belirgin bir etyoloji bulunamamaktadır.
- TGK yaşayan çiftler gelecekte canlı ve sağlıklı bir bebeğe ulaşma şanslarını arttırmak için etkinliği gösterilmemiş tedavilere kolaylıkla yönlenebil-mekte ve bu konuda çoğu zaman klinisyenlere baskı uygulamaktadırlar.
- Sağlık hizmetlerinde kaynakların doğru kullanı-mı için etkisiz tıbbi testlerin kullanıkullanı-mından kaçın-mak gerekir.
- Yeni tıbbi testler rutin kullanıma girmeden önce ayrıntılı şekilde değerlendirilmeli ve bu sayede yanlış tanıların konulmasının ya da zarar verme potansiyeli olan tedavilerin kullanımının önüne geçilmelidir.
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