Gestasyonel trombositopenili gebelerin maternal ve fetal sonuçlarının değerlendirilmesi
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Tarih
2022
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Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Gestasyonel trombositopeninin gebelerde maternal ve fetal olumsuz sonuçlar ile ilişkisini araştırmayı planladık. Yöntem: Retrospektif vaka çalışması olarak planlanan araştırma Ocak 2010- Mayıs 2021 yılları arasında Dicle Üniversitesi Tıp Fakültesi Hastanesi Kadın Hastalıkları ve Doğum Kliniği'nde yürütüldü. Araştırmaya trombositopeniye sebep olacak hiçbir ek hastalığı olmayan gebeliği esnasında gestasyonel trombositopeni tanısı alan ve doğumları kliniğimizde gerçekleşen 97 hasta dahil edildi. Hastalar, trombosit değerlerine göre iki gruba ayrıldı. Grup-1 trombosit sayısı<70.000/mm3 ve Grup-2 trombosit sayısı 70.000-150.000/mm3 olacak şekilde oluşturuldu, subgruplar kendi arasında karşılaştırıldı. Hastaların ve bebeklerin mevcut verileri ve laboratuvar sonuçları dosyalar geriye doğru taranarak ve hastalar telefonla aranarak elde edildi. Gruplar arasındaki verilerin analizi yapıldı. Olumsuz perinatal sonuçlar logistik regresyon analizi yapılarak değerlendirildi. Analiz sonuçlarında p<0.05 anlamlı kabul edildi. Bulgular: Gestasyonel trombositopeni tanısı olan hastaların laboratuvar verilerinden trombositleri ortalama 85.28±27.08 (min-max: 22-142), ortalama hematokrit 35.91±3.63 (min-max: 21-45) idi. Gruplar hematokrit değerleri göz önüne alınarak değerlendirildiğinde; Grup-2'deki hastaların ortalama hematokrit değeri (36.42 ± 3.22), Grup-1'deki hastaların ortalama hematokrit değerinden (34.26 ± 4.39) yüksek olup, arada istatiksel olarak anlamlı fark bulundu (p:0.03). Bu istatiksel anlamlı farklılık, trombosit değeri 110.000 sınır olarak alındığında da mevcuttu (p:0.039). Grup-1'de ALT değerleri (16.27±10.89), Grup-2'ye göre (13.52±9.57) istatiksel olarak anlamlı şekilde yüksekti (p:0.01). Ancak iki grup arasında AST, Kreatinin, üre, APTT, PT, INR, APGAR 1.dk ortalamaları, doğum ağırlığı ve fetal boy açısından anlamlı farklılık saptanmamıştır (p>0.05). Obstetrik komplikasyon görülme durumları, ek cerrahi girişim ve maternal yoğun bakım ihtiyacı karşılaştırıldığında; iki grup arasında istatistiksel olarak anlamlı farklılık saptanmamıştır (p>0.05). Grup-2'de 5. Dk APGAR skoru ortalaması (8.49 ± 0.97) ise, Grup-1'e (7.96 ± 0.88) kıyasla anlamlı oranda daha yüksek saptanmıştır (p:0.01). Grup-1'de kan iii transfüzyonu gerekme oranı Grup-2'ye göre anlamlı oranda daha yüksekti (p:0.001). Gruplar arasında eritrosit transfüzyonu açısından istatiksel anlamlı farklılık mevcuttu (p:0.033). Bu istatiksel anlamlı farklılık trombosit değeri 80.000 sınır olarak alındığında da mevcuttu (p:0.002). Grup-1'de Grup-2'ye göre trombosit transfüzyonu ihtiyacı anlamlı olarak daha yüksek bulundu (p:0.01). Bu istatiksel anlamlı farklılığın sınır trombosit değeri 100.000 olarak alındığında da devam ettiği görüldü (p:0.013). Grup-1'de Grup-2'ye göre TDP transfüzyonu ihtiyacının istatiksel olarak daha yüksek olduğu görüldü (p:0.02). Her iki grup arasında neonatal trombositopeni açısından istatiksel olarak anlamlı farklılık görülmedi (p:0.139). Sınır değer 50.000 olarak alındığında da neonatal trombositopeni açısından istatiksel anlamlı farklılık saptanmadı (p:0.455). Gestasyonel trombositopeninin sonraki gebeliklerde tekrarlayabildiği görüldü. Sonuç: Gestasyonel trombositopeni tanısı alan ve trombosit değerleri 70.000 altında olan hastalarda APGAR skorları düşük olmaktadır ve kan transfüzyonu (eritrosit süspansiyonu, TDP ve trombosit ürünü) ihtiyacı daha fazla olmaktadır. Eritrosit transfüzyonu ihtiyacı trombosit sınırı 80.000, trombosit transfüzyonu ihtiyacı sınır değer 100.000 alındığında dahi devam etmektedir.
Aim: We planned to investigate the relationship between gestational thrombocytopenia and adverse maternal and fetal outcomes in pregnant women. Material-Method: The study, which was planned as a retrospective case study, was carried out between January 2010 and May 2021 in the Gynecology and Obstetrics Clinic of Dicle University Medical Faculty Hospital. 97 patients who were diagnosed with gestational thrombocytopenia during pregnancy and had no another disease that cause thrombocytopenia and delivered in our clinic were included in the study. The patients were divided into two groups according to their platelet values. Group-1 platelet count was <70.000/mm3 and Group-2 platelet count was 70.000- 150.000/mm3 . Subgroups were compared among themselves. Current data and laboratory results of patients and infants were obtained by scanning the files backwards and by calling the patients by telephone. Analysis of data between groups was made. In the analysis of negative perinatal outcomes, logistic regression analysis was performed. P <0.05 was considered significant in the analysis results. Results: From the laboratory data of the patients diagnosed with gestational thrombocytopenia, mean platelet count was 85.28±27.08 (min-max: 22-142) and mean hematocrit was 35.91±3.63 (min-max: 21-45). When the groups were evaluated considering their hematocrit values; the mean hematocrit value of the patients in Group-2 (36.42 ± 3.22) was higher than the mean hematocrit value (34.26 ± 4.39) of the patients in Group-1, and a statistically significant difference was found between them (p:0.03). This statistically significant difference was also present when the platelet value was taken as the limit of 110,000 (p:0.039). ALT values in Group-1 (16.27±10.89) were statistically significantly higher than Group-2 (13.52±9.57) (p:0.01). However, no significant difference was found between the two groups in terms of AST, creatinine, urea, APTT, PT, INR, APGAR 1 minute mean, birth weight and fetal height (p>0.05). When the incidence of obstetric complications, additional surgical intervention and the need for maternal intensive care were compared, no significant difference was found between the two groups in terms of any of these parameters (p>0.05). v In Group-2, the 5th minute mean APGAR score (8.49 ± 0.97) was found to be significantly higher than in Group-1 (7.96 ± 0.88) (p:0.01). The rate of needing blood transfusion was significantly higher in Group-1 than in Group-2 (p:0.001). There was a statistically significant difference between the groups in terms of erythrocyte transfusion (p: 0.033). This statistically significant difference was also present when the platelet value was taken as the limit of 80,000 (p: 0.002). The need for platelet transfusion was found to be significantly higher in Group-1 than in Group-2 (p:0.01). It was observed that this statistically significant difference continued even when the border platelet value was taken as 100,000 (p:0.013). It was observed that the need for FFP transfusion was statistically higher in Group-1 than in Group-2 (p:0.02). There was no statistically significant difference between the two groups in terms of neonatal thrombocytopenia (p:0.139). Even when the cut-off value was taken as 50,000, no statistically significant difference was found in terms of neonatal thrombocytopenia (p:0.455). It was observed that gestational thrombocytopenia could recur in subsequent pregnancies. Conclusion: Apgar scores are lower in patients diagnosed with gestational thrombocytopenia and with platelet values below 70,000, and the need for blood transfusion (erythrocyte suspension, FFP and platelet product) is higher. The need for erythrocyte transfusion continues even when the platelet limit is 80,000, and the need for platelet transfusion is 100,000.
Aim: We planned to investigate the relationship between gestational thrombocytopenia and adverse maternal and fetal outcomes in pregnant women. Material-Method: The study, which was planned as a retrospective case study, was carried out between January 2010 and May 2021 in the Gynecology and Obstetrics Clinic of Dicle University Medical Faculty Hospital. 97 patients who were diagnosed with gestational thrombocytopenia during pregnancy and had no another disease that cause thrombocytopenia and delivered in our clinic were included in the study. The patients were divided into two groups according to their platelet values. Group-1 platelet count was <70.000/mm3 and Group-2 platelet count was 70.000- 150.000/mm3 . Subgroups were compared among themselves. Current data and laboratory results of patients and infants were obtained by scanning the files backwards and by calling the patients by telephone. Analysis of data between groups was made. In the analysis of negative perinatal outcomes, logistic regression analysis was performed. P <0.05 was considered significant in the analysis results. Results: From the laboratory data of the patients diagnosed with gestational thrombocytopenia, mean platelet count was 85.28±27.08 (min-max: 22-142) and mean hematocrit was 35.91±3.63 (min-max: 21-45). When the groups were evaluated considering their hematocrit values; the mean hematocrit value of the patients in Group-2 (36.42 ± 3.22) was higher than the mean hematocrit value (34.26 ± 4.39) of the patients in Group-1, and a statistically significant difference was found between them (p:0.03). This statistically significant difference was also present when the platelet value was taken as the limit of 110,000 (p:0.039). ALT values in Group-1 (16.27±10.89) were statistically significantly higher than Group-2 (13.52±9.57) (p:0.01). However, no significant difference was found between the two groups in terms of AST, creatinine, urea, APTT, PT, INR, APGAR 1 minute mean, birth weight and fetal height (p>0.05). When the incidence of obstetric complications, additional surgical intervention and the need for maternal intensive care were compared, no significant difference was found between the two groups in terms of any of these parameters (p>0.05). v In Group-2, the 5th minute mean APGAR score (8.49 ± 0.97) was found to be significantly higher than in Group-1 (7.96 ± 0.88) (p:0.01). The rate of needing blood transfusion was significantly higher in Group-1 than in Group-2 (p:0.001). There was a statistically significant difference between the groups in terms of erythrocyte transfusion (p: 0.033). This statistically significant difference was also present when the platelet value was taken as the limit of 80,000 (p: 0.002). The need for platelet transfusion was found to be significantly higher in Group-1 than in Group-2 (p:0.01). It was observed that this statistically significant difference continued even when the border platelet value was taken as 100,000 (p:0.013). It was observed that the need for FFP transfusion was statistically higher in Group-1 than in Group-2 (p:0.02). There was no statistically significant difference between the two groups in terms of neonatal thrombocytopenia (p:0.139). Even when the cut-off value was taken as 50,000, no statistically significant difference was found in terms of neonatal thrombocytopenia (p:0.455). It was observed that gestational thrombocytopenia could recur in subsequent pregnancies. Conclusion: Apgar scores are lower in patients diagnosed with gestational thrombocytopenia and with platelet values below 70,000, and the need for blood transfusion (erythrocyte suspension, FFP and platelet product) is higher. The need for erythrocyte transfusion continues even when the platelet limit is 80,000, and the need for platelet transfusion is 100,000.
Açıklama
Anahtar Kelimeler
Gestasyonel trombositopeni, Gebelik, Olumsuz maternal ve fetal sonuçlar, Gestational thrombocytopenia, Pregnancy, Adverse maternal and fetal outcomes
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Sunar, N. (2022). Gestasyonel trombositopenili gebelerin maternal ve fetal sonuçlarının değerlendirilmesi. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
