Gebeliğin Geç Sonlandırılması: Üçüncü Basamak Bir Tıp Merkezinde 243 Gebeliğin Retrospektif Olarak Değerlendirilmesi
Abstract
ÖZ
Amaç: Bu çalışma, 24. gebelik haftasından sonra yapılan geç gebelik terminasyonu endikasyonlarının yıllar içindeki değişimini değerlendirmeyi amaçlamıştır.
Gereç ve Yöntemler: Akdeniz Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı'nda Ocak 2007 ile Aralık 2022 tarihleri arasında fetal anormallik tanısı sonrası geç gebelik terminasyonu talep eden bir kohort retrospektif olarak değerlendirildi. Olgular 8 yıllık zaman aralıklarındaki vakaları içeren iki gruba ayrıldı: Ocak 2007'den Aralık 2014'e kadar olan olgular Grup 1 ve Ocak 2015'ten Aralık 2022'ye kadar olan olgular Grup 2 olarak tanımlandı.
Bulgular: Analizde Grup 1'de 127 (%52,3) ve Grup 2'de 116 (%47,7) olmak üzere toplam 243 vaka değerlendirildi. Son on altı yılda geç gebelik terminasyonun en sık nedenleri MSS (merkezi sinir sistemi) anomalileri (%43,2), kardiyovasküler sistem anomalileri (%17,3) ve kromozomal anormalliklerdi (%11,1). Yıllar içinde kardiyovasküler sistem anomalileri ve kromozomal anormallikleri olan vakaların yüzdesinde dikkate değer bir artış gözlendi (p<0.05).
Sonuç: Bu çalışma, gebeliğin geç terminasyon endikasyonlarının yıllar içindeki değişimine ilişkin bilgiler vermektedir. Özellikle üçüncü trimesterde, MSS anomalileri geç gebelik terminasyonunun önemli bir nedenidir. Standart ikinci trimester anatomik taramaya ilave olarak kısıtlı birinci trimester anatomik tarama ve üçüncü trimester nörosonogramı fetal anomalilerin tanısına katkı sağlayacaktır. Sonuç olarak; tarama stratejilerinin yaygınlaştırılması fetal anormallikler nedeniyle gebeliğin geç sonlandırılmasına olan ihtiyacı da azaltacaktır.
References
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- 2. Stoll C, Alembik Y, Dott B, Roth MP. Impact of prenatal diagnosis on livebirth prevalence of children with congenital anomalies. Annales de genetique 2002; 45(3):115-21.
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Late Termination of Pregnancy: A Retrospective Evaluation of 243 Pregnancies In A Tertiary Medical Center
Abstract
Objective: This study aims to assess changes in the indications for late termination of pregnancy performed after 24 weeks of gestation over the years.
Material and Methods: We performed a retrospective analysis of a cohort who requested late termination of pregnancy after a diagnosis of fetal abnormality at the Department of Obstetrics and Gynecology, Akdeniz University Faculty of Medicine, between January 2007 and December 2022. The cases were divided into two groups with 8-year time intervals: Group 1 spanning from January 2007 to December 2014, and Group 2 spanning from January 2015 to December 2022.
Results: A total of 243 cases were evaluated in the analysis, with 127 (52.3%) cases in Group 1 and 116 (47.7%) cases in Group 2. Over the past sixteen years, the most frequent reasons for late termination of pregnancy involving fetuses were central nervous system malformations (43.2%), cardiovascular system anomalies (17.3%), and chromosomal abnormalities (11.1%). A significant increase was noted over the course of time in the percentage of instances presenting cardiovascular system anomalies and chromosomal abnormalities (p<0.05).
Conclusion: This analysis provides insight into the causes of late termination of pregnancy. Especially in the third trimester, central nervous system anomalies are an important cause of late termination of pregnancy. In addition to standard second-trimester anatomical scanning, limited first-trimester anatomical scanning and third-trimester neurosonogram will contribute to the diagnosis of fetal anomalies. In conclusion, expanding screening strategies will also reduce the need for late termination of pregnancy due to fetal abnormalities.
References
- 1. Peller AJ, Westgate MN, Holmes LB. Trends in congenital malformations, 1974-1999: effect of prenatal diagnosis and elective termination. Obstetrics and Gynecology 2004; 104(5 Pt 1):957-64.
- 2. Stoll C, Alembik Y, Dott B, Roth MP. Impact of prenatal diagnosis on livebirth prevalence of children with congenital anomalies. Annales de genetique 2002; 45(3):115-21.
- 3. Carlson LM, Vora NL. Prenatal Diagnosis: Screening and Diagnostic Tools. Obstetrics and gynecology clinics of North America 2017; 44(2):245-56.
- 4. Schechtman KB, Gray DL, Baty JD, Rothman SM. Decision-making for termination of pregnancies with fetal anomalies: analysis of 53,000 pregnancies. Obstetrics and Gynecology 2002; 99(2):216-22.
- 5. Garne E, Khoshnood B, Loane M, Boyd P, Dolk H. Termination of pregnancy for fetal anomaly after 23 weeks of gestation: a European register-based study. BJOG : an international journal of obstetrics and gynaecology 2010; 117(6):660-6.
- 6. Leung TN, Ching Chau MM, Chang JJ, Leung TY, Fung TY, Lau TK. Attitudes towards the termination of pregnancy among Hong Kong Chinese women attending prenatal diagnosis counselling clinic. Prenatal diagnosis 2004; 24(7):546-51.
- 7. Kandel I, Merrick J. Late termination of pregnancy. Professional dilemmas. TheScientificWorldJournal 2003; 3:903-12.
- 8. Wool C. Systematic review of the literature: parental outcomes after diagnosis of fetal anomaly. Advances in neonatal care : official journal of the National Association of Neonatal Nurses 2011; 11(3):182-92.
- 9. Lalor J, Begley CM, Galavan E. Recasting Hope: a process of adaptation following fetal anomaly diagnosis. Social science & medicine (1982) 2009; 68(3):462-72.
- 10. Gissler M, Fronteira I, Jahn A, Karro H, Moreau C, Oliveira da Silva M, Olsen J, Savona-Ventura C, Temmerman M, Hemminki E; REPROSTAT group. Terminations of pregnancy in the European Union. BJOG : an international journal of obstetrics and gynaecology 2012; 119(3):324-32.
- 11. Turkey. Law on Population Planning No. 2827. 1983, 24 May 1983, [accessed 11 February 2022]. available at: https://www. refworld.org/docid/4c4476752.html
- 12. World Health Organization (2020) Classification of diseases (ICD). World Health Organization, Geneva.
- 13. Salomon LJ, Alfirevic Z, Berghella V, Bilardo CM, Chalouhi GE, Da Silva Costa F, Hernandez-Andrade E, Malinger G, Munoz H, Paladini D, Prefumo F, Sotiriadis A, Toi A, Lee W. ISUOG Practice Guidelines (updated): routine mid-trimester fetal ultrasound scan performance. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2022; 59(6):840-56.
- 14. ACOG. Practice Bulletin No. 175: Ultrasound in Pregnancy. Obstetrics and gynecology. 2016;128(6):e241-e56.
- 15. Excellence. NIfHaC.Abortion care (NICE guideline NG140). Sept 2019.
- 16. National Collaborating Centre for Ws, Children's H. National Institute for Health and Clinical Excellence: Guidance. Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: RCOG Press Copyright © 2008, National Collaborating Centre for Women’s and Children’s Health.; 2008.
- 17. Dommergues M, Benachi A, Benifla JL, des Noëttes R, Dumez Y. The reasons for termination of pregnancy in the third trimester. British journal of obstetrics and gynaecology 1999; 106(4):297-303.
- 18. Bosma JM, van der Wal G, Hosman-Benjaminse SL. Late termination of pregnancy in North Holland. British journal of obstetrics and gynaecology 1997; 104(4):478-87.
- 19. Dickinson JE. Late pregnancy termination within a legislated medical environment. The Australian & New Zealand journal of obstetrics & gynaecology 2004; 44(4):337-41.
- 20. Taipale P, Ammälä M, Salonen R, Hiilesmaa V. Learning curve in ultrasonographic screening for selected fetal structural anomalies in early pregnancy. Obstetrics and gynecology 2003; 101(2):273-8.
- 21. Cameron M, Moran P. Prenatal screening and diagnosis of neural tube defects. Prenatal diagnosis 2009; 29(4):402-11.
- 22. Yinon Y, Katorza E, Nassie DI, Ben-Meir E, Gindes L, Hoffmann C, Lipitz S, Achiron R, Weisz B. Late fetal central nervous system anomalies diagnosis following a normal second trimester anatomy scan. Prenatal diagnosis 2013; 33(10):929-34.
- 23. Allan LD. Cardiac anatomy screening: what is the best time for screening in pregnancy? Current opinion in obstetrics & gynecology 2003; 15(2):143-6.
- 24. Syngelaki A, Hammami A, Bower S, Zidere V, Akolekar R, Nicolaides KH. Diagnosis of fetal non-chromosomal abnormalities on routine ultrasound examination at 11-13 weeks' gestation. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2019; 54(4):468-76.
- 25. Liao Y, Wen H, Ouyang S, Yuan Y, Bi J, Guan Y, Fu Q, Yang X, Guo W, Huang Y, Zeng Q, Qin Y, Xiang H, Li S. Routine first-trimester ultrasound screening using a standardized anatomical protocol. American journal of obstetrics and gynecology 2021; 224(4):396.e1-.e15.
- 26. Ficara A, Syngelaki A, Hammami A, Akolekar R, Nicolaides KH. Value of routine ultrasound examination at 35-37 weeks' gestation in diagnosis of fetal abnormalities. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2020; 55(1):75-80.
Details
| Primary Language | English |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | May 22, 2025 |
| Publication Date | May 28, 2025 |
| Submission Date | September 18, 2023 |
| Published in Issue | Year 2025 Volume: 11 Issue: 2 |
