-135 Orijinal makale Primigravid Pre- ÖZET Amaç: - Materyel ve Metot: - - tir. Bulgular: dilen primigravid preeklamptik gebelerin %30,8 i hafif preeklampsi grubuna (Grup 1), %69,2 si 2) dahil edildi. H -41) idi ve her iki grupta da benzerdi (p:0,3 gebelik öncesi vücut kitle indeksi ve gebelik süresince (p:0,72 ve ryen ile - - - Sonuç: Maternal ve neonatal komplik - - geçirilmelidir. K -. Anahtar Kelimeler: Preeklampsi; neonatal morbidite; preekla ABSTRACT Epidemiologic investigation of primigravid preeclamptic patients Aim: The aim of this study is to define and evaluate the potential risk factors to be investigated in terms of the severity of preeclampsia in primigravid patients. Material and Method: Four hundred and fifty preeclamptic primigravid pregnant women admitted to the Dr. Zekai Tahir Burak Women Health Research and Education Hospital, Perinatology Clinic were included in to the study between January 1, 2003 and November 31, 2007. All the demographic values and laboratory results were investigated retrospectively. Results: Most of the primigravid preeclamptic patients (69.2%) were included into Group 2 (severe preeclempsia), whereas 30,8% of them into Group 1 (mild preeclampsia). The mean age of the patients was 24 (16-41) years old, and similar between both of the groups (p:0,30). The mean of body mass indexes of the pre-pregnancy period and the weight gaining during the pregnancy were similar in both groups (p:0,72 and p: 0,36, respectively). The presences of smoking and regular antenatal visits were not related with the severity of preeclampsia. The diagnosis was established earlier gestational week in severe preeclampsia than the mild one, and the main route of delivery was cesarean section in severe preeclampsia. Neonatal morbidities and mortalities were all higher in Group 2. Forty-one percent of the patients did not have any symptoms during the first admission of the hospital, the routine investigations revealed the diagnosis of preeclampsia mostly. Hemoconcentration was mainly seen in severe preeclampsia, and liver enzyme dysfunction was also common in the same group. Conclusion: In order to prevent maternal and neonatal complications, the early diagnosis of preeclampsia is mandatory. To determine the incidence and possible risk factors of preeclampsia environmental conditions and circumstances should be investigated periodically. With the increasing city life and maternal age of planned pregnancy due to participating of women in daily working life, preeclampsia may be thought as emerging problem in the near future. Key Words: Preeclampsia; neonatal morbidity; severity of preeclampsia G Preeklampsi, tüm dünyada hem maternal hem de perinatal mortalite ve morbiditenin önde gelen e-mail: drsibela@yahoo.com.tr : 16.07.2012 : 15.08.2012 sebeplerinden birisidir 1. Dünya genelinde tüm gebeliklerin ortalama %3,1 nin preeklampsi ile - kt tedir 2-4 131
- lirken, Lawler ve ark. 77, 5,6-7. Türkiye de Büyükören ve ark. 8. Preeklampsi için risk faktörl - 1,2,6 ailede hipertansiyon, k lupus gibi otoim- - hidrops fetalis, kötü kontrollü diyabet, mol hidatiform, pozitif kardiolipin testi, genetik faktörler, - olmazsa paritenin koruyucu etkisi ortadan kalkar 9. preeklampsi g 2,10. - isten Preeklampsi öyküsü, sadece bir sonraki gebelikte preeklampsi a ileride ortaya 11. bunda gösterilen primigravid preeklamptik gebe- MATERYAL VE METOT 1 Ocak 2003 - K nde yatarak ted 313 idi. - primigravid hasta dahil edildi. Kronik hipertansi- - l edilen 445 hasta, klinik ve labora- olarak iki alt grupta incelendi. Gruplardan elde edilen veriler birbirleri ve literatür ile benzerlikler ç protei 300 mg tüm bilgiler, protokol defterleri ve ar -küretaj öyküsü, ultrasonografi (USG) ve son adet tarihine (SAT) -sigara kul k be jen, glukoz, kara- siyon testleri (AST, ALT), laktat dehidrogenaz (LDH), total protein, albumin, böbrek fonksiyon testleri (üre, kreatinin), bilirubin, ekli, APGAR skoru (1. ve 5. dakikadaki) not edildi. (Sistolik TA + (Diastolik TA x2)/ afif hipertansiyon, hipertansiyon olarak kabul edildi. A üri (5 gr/24 saat) üri (500 ml/24 saat) üel bulgular n en az 3 ) based stati -Kare - Whi nicel veriler için aritmetik ortalama +/- standart BULGULAR eek- 8) hafif preeklampsi (Grup 1), 308 i (% 69, - -41) olarak tespit edildi. 132
i % kati - %6,3 ünün (n: 2 unun (n:82) 26-35 kg/m 2 ve sadece %4,9 unun (n:23) >35 kg/m 2 o 0,72) (Tablo 1). Gebelik es- a her iki grupta benzer idi (p:0,36). - 01) - - sahip olan gebelerin %40,3 ü (n: 242) hafif preeklampsi grubunda idi (p<0,01). %95,1 inin preeklampsi grubunda d (p:0,75). i rupta da benzer olarak has- 78). benzer oranlarda düzenli olarak antenatal takibe geldikleri görüldü (p:0,76). Preeklampsi nedeniyle izlenen toplam 445 has- Hastalardan sadece 63 ünün (%14,2) ailesinde hipertansiyon öyküsü mevcuttu. %41 inin lampsi üel - Hastaneye ilk geli - 37,2 sinde ödem y her iki g 0,45). memi tir (p:0,45). ; kreatinin, total protein, albumin, total bilirubin ve 33,2 s - p bu 89) gebelik süresince - i Sezarye nin (n: görüldü (p<0,01). Hastalardaki maternal ve fetal komplikasyon- kati çekmektedir (Tablo 3). Hafif preeklampsi gru- ternal komplikasyon görülmezken, tür. preeklamptik grupta ortalama 2005 gr idi (p<0,01). - - Preeklamptik gebelerde umblikal arter Doppler - Tablo 1 Demografik Özelliklerin Hafif Preeklampsi (N: 137) (N: 308) - SD 24 +/- 4 24 +/- 5 0,30 - SD (kg/m 2 )(gebelik öncesi) 24 +/- 4,2 23,9 +/- 4,2 0,72 - SD 14,8 +/- 5,7 14,3 +/- 5,5 0,36 - SD 36,8 +/- 3,4 34,7 +/- 4 <0.01 - SD 35,6 +/- 4,1 33,5 +/- 4,2 <0.01 133
Tablo 2. Preeklampsi iddetine Göre H Laboratuar Hafif Preeklampsi (N: 137) (N: 308) Hemoglobin (gr/dl), ort. +/- SD 11,8 +/-1,9 12,7+/-1,7 <0,01 Hematokrit (%), ort. +/- SD 35,9 +/-5,5 38,1+/-5,6 <0,01 Platelet (mm 3 ), ort. +/- SD 228,000 +/-72,600 197,000+/-103,000 <0,01 INR, ort. +/- SD 0,91 +/-0,13 0,90+/-0,14 0,59 Fibrinojen (mg/dl), ort. +/- SD 506 +/-120 491+/-138 0,28 BUN (mg/d), ort. +/- SD 26 +/-9,8 32+/-15 <0,01 Kreatinin (mg/dl), ort. +/- SD 0,7 +/-0,04 0,9+/-0,08 0,14 AST (U/l), ort. +/- SD 25 +/-9,7 91,2+/-8,7 <0,01 ALT (U/l), ort. +/- SD 16,2 +/-10,7 71,3+/-9 <0,01 Tot. Bilirubin (mg/dl), ort. +/- SD 0,44 +/-0,05 0, 58+/-0,22 0,75 LDH (U/l), ort. +/- SD 611 +/-252 867+/-520 0,18 *, p d Tablo 3 Maternal Komplikasyon Fetal komplikasyonlar Hafif Preeklampsi, N (%) N (%) Yok 110 (89,6) 200 (67,3) HELLP - 57 (19,1) Eklampsi - 9 (3) 5 (4) 9 (3) Atoni 2,4 (3) 0,7 (2) Yok 78 (63, 9) 77 (25, 8) Prematurite 20 (16, 3) 119 (40, 3) Mekonyum aspirasyonu 1 (0, 9) 4 (1, 4) 5 (4, 3) 30 (10, 1) Exitus 7 (5, 7) 30 (10, 1). <0,01 <0,01 Hastalar ortalama tedavi süresi 4 gün (1-38 gün) iken 4-7 gün süre ile 80,8 i- (p<0,01). Odegard RA ve ark. serilerinde 10 nulliparite ora- mizde Toyran ve ark. 12 la parite durumu (16-41) olup, ol -25 ya lmektedir. Literatürde de 35 ya ve üzeri gebelikler, 20 ya in belirgin olarak genç ya 13. Bununla birlikte genç multiparlara oranla, ileri ya multipar gebe- belirtilmektedir 13. Bu da çal - 12,13 birlikte bölgede, %33 ünü yu desteklemektedir. - 14-95,1) sigara içm la n bir - - n 15 - - Preeklampsinin önlenmesinde en önemli faktörler iyi antenatal takiptir 2,13. Preeklampsi hastala (%69,1) düzenli 134
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