[PP-075]
Preeklampsili Gebeler ile Normal Gebelerde Ortalama Trombosit Hacmi Değerinin (MPV) Karşılaştırılması
Zehra Yılmaz, Elif Yılmaz, Duygu Doğdu, Ismail Burak Gültekin, Osman Fadıl Kara, Tuncay Küçüközkan
Dr.Sami Ulus Kadın Doğum,Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi,Ankara,Türkiye
Giriş
tanesidir. Preeklampsi patogenezinde en sık maternal spiral arterlerin yetersiz invazyonu suçlanmakla birlikte, trombosit fonksiyonlarındaki değişikliklerin de preeklampsiye neden
olabileceğini gösteren çalışmalar mevcuttur. MPV (Ortama Trombosit Hacmi ) platelet aktivasyonu ve fonksiyonunu gösteren bir belirteçtir aynı zamanda inflamatuar belirteçi olarak da
kullanılmaktadır. Biz bu çalışmamızda preeklampsi ve normal gebelerdeki MPV değerini karşılaştırmayı amaçladık.
Yöntem
Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları E.A.H. Yüksek Riskli Gebelik servisine Ocak 2013-Ocak 2015 tarihleri arasında preeklampsi tanısı ile yatırılan hastaların bilgileri tarandı. Hastaların yaşı, gestasyonel yaşı, idrardaki protein miktarı, kan sayımı parametreleri kaydedildi. Kontrol grubu olarak aynı dönemde polikliniğimize rutin kontrole gelen gebe hastalar seçildi. Preeklampsi hastaları ile kontrol; aynı zamanda hafif preeklampsi ile şiddetli preeklampsi grubundaki hastaların MPV değerleri karşılaştırıldı.
Bulgular
Toplam 94 preeklampsi 91 kontrol olmak üzere 185 hasta çalışmaya dahil edildi. Kontrol grubunda ortalama yaş 27,17±6,26; preeklampsi grubunda ortalama yaş 27,90±6,71 idi (p=0,44).
Preeklampsi grubunda ortalama gestasyonel hafta 34,62±3,55; kontrol grubunda 35,26±3,33 idi (p=0,21). Preeklampsi grubunda ortalama MPV değeri 9,76±1,09; kontrol grubunda 9,46 ± 1,14 idi her iki grupta istatistiksel olarak anlamlı fark yoktu (p=0,074).Toplam 63 hasta hafif, 32 hasta şiddetli preeklampsi olarak değerlendirildi. Her iki grupta da MPV değerleri arasında fark
saptanmadı. (9,66±1,12, 9,85±1,035,p=0,44,sırasıyla) Sonuç
MPV değerinin bazı sistemik hastalıklarda prognostik faktör olarak kullanılabileceği ile ilgili
çalışmalar mevcuttur. Literatürde MPV değeri ile preeklampsi şiddeti arasında sınırlı sayıda çalışma mevcut olup, sonuçlar çelişkilidir. Biz bu çalışmamızda MPV değeri ile preeklampsi ve preeklampsi şiddeti arasında fark saptamadık.
Anahtar Kelimeler: Preeklampsi, Gebelik, MPV
[PP-077]
Single Dose Antenatal Corticosteroid Application for Women at Risk of Preterm Labor
Mehmet Sinan Beksaç1, Taner Kasapoğlu2, Ayşe Korkmaz3, Ergun Karaağaoğlu4
1Department of Obstetrics and Gynecology, Perinatology Unit, School of Medicine, Hacettepe University, Ankara, TURKEY
2Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Ankara, TURKEY; Department of Epidemiology, Institute of Health Sciences, Hacettepe University, Ankara, TURKEY
3Department of Pediatrics, Neonatology Unit, School of Medicine, Hacettepe University, Ankara, TURKEY
4Department of Biostatistics, School of Medicine, Hacettepe University, Ankara, TURKEY
This study population consisted of 1252 preterm birth cases inbetween
January2006-December2008 at the Ob/Gyn Department of Hacettepe University, Turkey. This retrospective cohort study is consisted of 547 preterm neonates delivered inbetween 24-34thgestational weeks. Average gestational week was 30,5±3,1. Study group (n:291) is consisted of the neonates of the pregnancies treated with a single course of steroid treatment defined as the use of 12mg doses of betamethasone twice, with births occurring between 24hours and 7days after the first dose. Viceversa, control group (n:202) consisted of neonates who had no antenatal corticosteroids. Patients with fetal abnormalities or medically terminated for another reasons weren’t included. Patients were divided into three groups; 24th-28 thweeks(Group1), 28th-32ndweeks(Group2), 32nd-34thweeks(Group3). In 24th-34thgestational weeks singleton pregnancies, pneumonia and sepsis frequency was higher in the study group (10,8%vs25,7% respectively) according to the control(3,6%vs14,5%)(p=0,033;p=0,030). In Group2, IVH and sepsis frequency was higher in study group(14,4%vs32,6%) according to the control(3,2%vs16,1%)(p=0,020;p=0,017). In Group3, sepsis frequency was higher in study group(10,2%) according to the control(6,6%). No overall decrease was seen in the incidence of RDS, conversely an increase in the incidence of RDS
was obviously noted in the study group(p=0,021,OR:1.672, 95%[CI] 1.080-2.590). Multivariate logistic regression analysis showed no statistical difference regarding the associated factors with the incidence of RDS. As a conclusion, the current regimen of antenatal corticosteroids utilized in singleton pregnancies does not reduce the overall incidence of RDS. Large population based and well-designed prospective cohort studies are needed to reveal the exact effects of antenatal corticosteroid administration on perinatal mobidity and mortality.
Keywords: antenatal corticosteroid, preterm labor, respiratory distress syndrome, neonatal
morbidity
[PP-078]
Maternal and fetal outcome of renal diseases
Nergis Kender1, Anil Erturk1, Sinan Beksac2
1Hacettepe University, Department of Gynecology and Obstetrics
2Hacettepe University, Department of Gynecology and Obstetrics, Division of Perinatology
Renal diseases are associated with both increased risk for adverse maternal outcomes, including gestational hypertension, preeclampsia, eclampsia, and death, and also adverse fetal outcomes, including preterm birth, intrauterine growth restriction, small for gestational age, and still birth. To reveal the different effects of groups of renal diseases on pregnancy, 44 pregnancies with renal diseases were evaluated at Hacettepe University Perinatology Clinic between January 2001 and March 2014. These pregnancies were divided into three groups, renal cystic diseases, primary glomerulonephritis and secondary glomerulonephritis due to systemic diseases. Infants’ birth weight, gestation age, 24-hour urine protein excretion just before delivery were detected
significantly different among these groups. It was determined that 21 of these 44 pregnancies were complicated with comorbidities such as preeclampsia, hypertension, HELLP syndrome.
Patients with renal disease should be monitored jointly by a nephrologist and by an obstetrician. Delivery should be planned before and ideally actualized at a tertiary referral center.