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Geç Preterm Doğumların Analizi: Yenidoğan Sonuçları Açısından Etyolojik Altgruplar Arasında Farklılıklar Var mı?

Yıl 2016, Cilt: 69 Sayı: 3, 239 - 241, 21.12.2016

Harun Egemen Tolunay

Öz

Amaç: Geç preterm doğumların etyolojik subgruplara göre yenidoğan sonuçlarının analizi ve geç preterm doğumlarda doğum endikasyonu ve yenidoğan morbiditesi arasında ilişki olup olmadığının değerlendirilmesi.

Gereç ve Yöntem: Bir üniversite hastanesinde meydana gelen 340/7–366/7 hafta arası (34 hafta ve 36 hafta 6 gün gebelikler) doğumlar 3 yıllık bir süre için incelendi. Doğum endikasyonları spontan ve tıbbi endikasyonla indüklenen doğumlar olarak sınıflandırıldı. Tıbbi endikasyonla indüklenen geç preterm doğumlar kanıta dayalı olan (ciddi preeklampsi, eklampsi, HELLP Sendromu, anormal fetal test, plasenta previa, kanamayla birlikte plasenta dekolmanı, stabil olmayan kötüye giden tıbbi durumlar) ve kanıta dayalı olmayan (hafif preeklampsi, normal fetal testlere eşlik eden intrauterin gelişme geriliği, normal fetal testlere eşlik eden oligohidramnioz, hafif stabil tıbbi durumlar) endikasyonlar olarak değerlendirildi.

Bulgular: Toplam geç preterm doğum sayısı 179 olarak bulundu. 118’i spontan, 61’i tıbbi endikasyonla indüklenen doğumlardı. Spontan geç preterm doğumların %76’sında membranların intakt, %24’ünde ise rüptüre olduğu bulundu. Tıbbi endikasyonla indüklenen geç preterm doğumların %52’si kanıta dayalı endikasyon ile doğurtulurken, %48’I ise kanıta dayalı olmayan endikasyonlar ile doğurtuldu. Yenidoğan yoğun bakım ihtiyacı her 2 grupta da benzerdi. Yenidoğan yoğun bakıma yatış endikasyonları arasında tek anlamlı fark enfeksiyon oranlarında izlendi (%7 spontan grup, %33 tıbbi endikasyonla indüklenen grup p<0,001). Kanıta Dayalı Olmayan doğum grubundaki kadınlar, Kanıta Dayalı grubundaki kadınlara gore anlamlı olarak daha yaşlı olarak hesaplandı (31.6 vs. 27.9; p=0,01) . Yenidoğan yoğun bakım yatış oranları kanıta dayalı olan grupta anlamlı olarak daha yüksekti. (40% vs. 7% p=0.003)

Sonuç: tıbbi endikasyonla indüklenen geç preterm doğumlar olguların 1/3 ünü oluşturmakta ve yüksek neonatal enfeksiyon oranına sahip olarak izlendi. Aynı şekilde neonatal morbiditenin de kanıta dayalı grupta daha yüksek olduğu görülmüştür.

Anahtar Kelimeler

Geç Preterm Doğum İyatrojenik Spontan

Etik Beyan

-

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Kaynakça

  • 1. Kramer MS. Later preterm birth: appreciable risks, risking incidence. J Pediatr 2009;154:159-160.
  • 2. Goldenberg RL, Culhane JF, Iams JD et al. Preterm birth 1. Epidemiology and causes of preterm birth. Lancet 2008; 371:75-84.
  • 3. Martin JA, Kirmeyer S, Osterman M et al. Born abit too early: recent trends in late preterm births. NCHS Data Brief 2009;24:1-8.
  • 4. Gyamfi-Bannerman C. Late preterm birth: management dilemmas. Obstet Gynecol Clin North Am 2012;39:35-45.
  • 5. Taylor HG. Outcomes of late preterm birth: who is at risk and for what? Am J Obstet Gynecol 2012;206:181-182.
  • 6. Gyamfi-Bannerman C, Fuchs KM, Young OM et al. Nonspontaneous late preterm birth: etiology and outcomes. Am J Obstet Gyneco 2011;205:451-456.
  • 7. Samra HA, McGrath JM, Wehbe M. An integrated review of developmental outcomes and late-preterm birth. J Obstet Gynecol Neonatal Nurs 2011;40:399-411.
  • 8. Aliaga S, Boggess K, Ivester TS et al. Influence of neonatal practice variation on outcomes of late preterm birth. Am J Perinatol 2014; 31:659-666.
  • 9. Aliaga S, Price W, McCaffrey M et al. Variation in late-preterm deliveries: a physician survey. J Perinatol 2013;33:347-351.
  • 10. Chauhan SP. Late preterm births: irreducible because E=mc2. Am J Obstet Gynecol 2011;204:459-460.
  • 11. McIntire D, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008;111:35-41.
  • 12. Raju TN, Higgins RD, Stark AR et al. Optimising care and outcome for late preterm infants: a summary of the workshop sponsored by the national institute of child health and human development. Pediatrics 2006;118:1207-1214.
  • 13. Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ et al. Differences in mortality between late-preterm and term singleton infants in the United States, 1995- 2002. J Pediatr 2007;151:450-456.
  • 14. Morais M, Mehta C, Murphy Ket al. How often are late preterm births the result of non-evidence based practices: analysis from a retrospective cohort study at two tertiary referral centres in a nationalised healthcare system. BJOG 2013; 120:1508-1514.

Analysis of Late Preterm Births: Are There any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?

Yıl 2016, Cilt: 69 Sayı: 3, 239 - 241, 21.12.2016

Harun Egemen Tolunay

Öz

Aim: To evaluate the neonatal outcomes of late preterm births (LBPs) according to etiologic subgroups and to evaluate if there is any association between birth indication and neonatal morbidity in late preterm births.

Material and Method: Singleton pregnancies delivered between 340/7–366/7 weeks (34 weeks and 36 weeks 6 days of pregnancy) during a 3-year period at a tertiary care university hospital were studied. Indications for delivery were classified as either spontaneous or inducted with medical indication. Inducted with medical indication LPBs were categorized as either evidence-based (EB) (eg. severe preeclampsia/eclampsia, HELLP syndrome, abnormal fetal test, placenta previa or placental abruption with vaginal bleeding, and unstable/worsening medical conditions) or non evidence-based (NEB) (mild preeclampsia, intrauterine growth restriction with normal fetal test, oligohydramnios with normal fetal test, and mild/stable medical conditions).

Results: There were 179 LPBs; 118 (66%) spontaneous and 61 (34%) inducted with medical indication. 76% of spontaneous LPBs were preterm labor with intact membranes and 24% were premature preterm rupture of membranes. 52% of inducted with medical indication LPBs were EB and 48% were NEB. The frequencies of neonatal intensive care unit (NICU) admissions were similar between the groups. The only significant difference among indications was infection rates in NICU (7% in the spontaneous vs. 33% in the inducted with medical indication group; P<0.001). Women with NEB deliveries were significantly older (31,6 vs. 27,9; P=0,010). NICU admission rates were significantly higher in the EB group, when compared to the NEB group (40% vs. 7%; P=,003)

Conclusion: Inducted with medical indication LPBs consist of almost one third of all LPBs and accompany high rates of neonatal infections. Also among inducted with medical indication LPBs, neonatal morbidity is higher in cases with EB indications, when compared with the NEB subgroup.

Anahtar Kelimeler

Late Preterm Births Iatrogenic Spontaneous

Etik Beyan

-

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Kaynakça

  • 1. Kramer MS. Later preterm birth: appreciable risks, risking incidence. J Pediatr 2009;154:159-160.
  • 2. Goldenberg RL, Culhane JF, Iams JD et al. Preterm birth 1. Epidemiology and causes of preterm birth. Lancet 2008; 371:75-84.
  • 3. Martin JA, Kirmeyer S, Osterman M et al. Born abit too early: recent trends in late preterm births. NCHS Data Brief 2009;24:1-8.
  • 4. Gyamfi-Bannerman C. Late preterm birth: management dilemmas. Obstet Gynecol Clin North Am 2012;39:35-45.
  • 5. Taylor HG. Outcomes of late preterm birth: who is at risk and for what? Am J Obstet Gynecol 2012;206:181-182.
  • 6. Gyamfi-Bannerman C, Fuchs KM, Young OM et al. Nonspontaneous late preterm birth: etiology and outcomes. Am J Obstet Gyneco 2011;205:451-456.
  • 7. Samra HA, McGrath JM, Wehbe M. An integrated review of developmental outcomes and late-preterm birth. J Obstet Gynecol Neonatal Nurs 2011;40:399-411.
  • 8. Aliaga S, Boggess K, Ivester TS et al. Influence of neonatal practice variation on outcomes of late preterm birth. Am J Perinatol 2014; 31:659-666.
  • 9. Aliaga S, Price W, McCaffrey M et al. Variation in late-preterm deliveries: a physician survey. J Perinatol 2013;33:347-351.
  • 10. Chauhan SP. Late preterm births: irreducible because E=mc2. Am J Obstet Gynecol 2011;204:459-460.
  • 11. McIntire D, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008;111:35-41.
  • 12. Raju TN, Higgins RD, Stark AR et al. Optimising care and outcome for late preterm infants: a summary of the workshop sponsored by the national institute of child health and human development. Pediatrics 2006;118:1207-1214.
  • 13. Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ et al. Differences in mortality between late-preterm and term singleton infants in the United States, 1995- 2002. J Pediatr 2007;151:450-456.
  • 14. Morais M, Mehta C, Murphy Ket al. How often are late preterm births the result of non-evidence based practices: analysis from a retrospective cohort study at two tertiary referral centres in a nationalised healthcare system. BJOG 2013; 120:1508-1514.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kadın Hastalıkları ve Doğum
Bölüm Makaleler
Yazarlar

Harun Egemen Tolunay

Proje Numarası -
Yayımlanma Tarihi 21 Aralık 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 69 Sayı: 3

Kaynak Göster

APA Tolunay, H. E. (2016). Analysis of Late Preterm Births: Are There any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 69(3), 239-241.
AMA Tolunay HE. Analysis of Late Preterm Births: Are There any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Aralık 2016;69(3):239-241.
Chicago Tolunay, Harun Egemen. “Analysis of Late Preterm Births: Are There Any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 69, sy. 3 (Aralık 2016): 239-41.
EndNote Tolunay HE (01 Aralık 2016) Analysis of Late Preterm Births: Are There any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?. Ankara Üniversitesi Tıp Fakültesi Mecmuası 69 3 239–241.
IEEE H. E. Tolunay, “Analysis of Late Preterm Births: Are There any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 69, sy. 3, ss. 239–241, 2016.
ISNAD Tolunay, Harun Egemen. “Analysis of Late Preterm Births: Are There Any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 69/3 (Aralık 2016), 239-241.
JAMA Tolunay HE. Analysis of Late Preterm Births: Are There any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2016;69:239–241.
MLA Tolunay, Harun Egemen. “Analysis of Late Preterm Births: Are There Any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 69, sy. 3, 2016, ss. 239-41.
Vancouver Tolunay HE. Analysis of Late Preterm Births: Are There any Differences Among Etiologic Subgroups in Terms of Neonatal Outcomes?. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2016;69(3):239-41.
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