Kliniğimizdeki konjenital anomali tiplerinin, dağılımının ve konjenital anomalili bebek doğuran gebelerin klinik ve demografik özelliklerinin retrospektif değerlendirilmesi: 5 yıllık tersiyer merkez deneyimi
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Tarih
2020
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Dicle Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmadaki amacımız, Dicle Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğinde, terminasyonu veya doğumu gerçekleştirilen konjenital anomalili bebeğe sahip annelerin klinik ve demografik özelliklerini değerlendirmek, konjenital anomalili gebeliklerin insidansını, anomali tiplerini ve anomalilerin dağılımını değerlendirmektir. Ortaya çıkacak sonuçlara göre; perinatal mortalite ve morbiditenin azalmasına katkıda bulunmak, konjenital anomalilerden kaynaklanan ciddi sağlık giderlerini, ailenin ve sağlık personelinin yaşamak zorunda kalacağı psikolojik, etik, sosyal travmaları azaltmak ve fetal anomalilerin yönetim şekline katkı sağlamak amaçlanmıştır. Materyal-Metot: Bu çalışmaya Temmuz 2013 ile Temmuz 2018 tarihleri arasında ( 5 yıllık ) Dicle Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği'ne konjenital anomali tanısı ile yatırılan ve doğumu veya terminasyonu gerçekleştirilen hastalar ( n=834) dahil edildi. Hastaların yaş, gravida, parite, gebelik haftası, ultrasonografik bulguları, doğum şekli, doğumdaki gebelik haftası, konjenital anomali tipi gibi verileri hastane bilgi yönetim sistemi arşivi ve kliniğimizin doğum defterleri incelenerek elde edilmiştir. Gebelik haftası ? 20 veya ? 500 gram gebelikler abortus olarak kabul edilmiştir. Minör anomaliler ve bulgular (koroid pleksus kisti, hiperekojen bağırsak, kısa femur, hiperekojenik kardiak odak, hafif düzeyde renal piyelektazi gibi) çalışma dışı tutuldu. Maternal veya tıbbi nedenli terminasyonlar çalışma dışında bırakıldı. Minör anomali veya soft markırlar saptanan ancak, farklı nedenlerle termine edilen veya doğurtulan gebeler çalışma dışı bırakıldı. Herhangi bir anomali olmaksızın istemli abortus yapan gebeler çalışmaya dahil edilmedi. Arşiv veya hastane bilgi yönetim sisteminden bilgilerine ulaşılamayan veya eksik bilgi elde edilen hastalar çalışma dışı bırakıldı. Bulgular: Çalışmayı yaptığımız süre içerisinde toplam 834 fetal anomalili bebek doğurtulmuştur. Kliniğimizdeki konjenital anomali oranı % 6,12 olarak tespit edilmiştir. Fetal anomaliler sistem sıklıklarına göre değerlendirildiğinde; SSS anomalilerinin 426 (%51,1) hasta olduğu ve SSS anomalilerinin en sık görülen anomaliler olduğu, deri-lenfatik sistem anomalisi 96 (%11,5) , multipl anomaliler 87 (%10,4), kardiyak anomaliler 74 (%8,9), GÜS anomalisi 59 (%7,1), GİS anomalisi 34 (% 4,1), kas-iskelet sistemi anomalisi 17 (%2), kromozom anomalisi 10 (%1,2), göğüs anomalisi 9 (%1,1), kranio-fasyal anomali 3 (%0,4) ve diğer anomalileri olan 18 (%2,2) hasta olduğu tespit edildi. En sık anomalilerin; bir grup olarak NTD (n=199) anomalileri (%23,9) olduğu, tek başına hidrosefalinin (n=104, (%24,4)) ise en sık izole anomali olduğu tespit edildi. Konjenital anomalisi olan hastalarda, sezaryen ile doğum yapanların oranlarının daha fazla olduğu ve bunun istatistiksel açıdan anlamlı olduğu görülmüştür (p< 0,001). Akraba evliliği ve sigara kullanımı ile, sık görülen konjenital anomaliler arasında herhangi bir ilişki olmadığı tespit edildi. Çalışmamızda miadından önce doğum yapan annelerin bebeklerinde, SSS anomalileri, deri lenfatik sistem anomalileri ve multipl anomalilerin daha sık görüldüğü ve bu sıklığın istatistiksel olarak anlamlı olduğu tespit edildi. Dişi ya da ambigus genitale olan bebeklerde SSS anomalilerinin, erkek bebeklerden daha fazla görüldüğü ve bu farkın istatistiksel olarak anlamlı olduğu tespit edildi (p=0,037). Sonuç: Fetal anomalilerin daha erken prenatal tanısı ve yasalar çerçevesinde daha erken gebelik haftala¬rında isteğe bağlı sonlandırılabilme imkanı, gebelerin sağlıklı ve malformasyon taşımayan bebek doğurma beklentisini arttırmıştrır. Ayrıca erken terminasyonlarda, etik ve psikolojik kabul edilebilirliğin daha yüksek olduğu görülmüştür. Kültürlerde ve ülkelerin yasalarında farklılıklar olsa da; erken dönemde tespit, özellikle yaşamla bağdaşmayan ağır anomaliler hakkında aileye daha etkin bir danışmanlık hizmetinin verilmesi ve terminasyon seçeneğinin, perinatal mortalitenin ve morbiditenin azaltılmasına katkıda bulunacağını, sağlık giderlerini ve ailenin yaşamak zorunda kalacağı psikolojik ve sosyal travmaları azaltacağını düşünmekteyiz. Her toplumda, hatta her bölgede konjenital malformasyon dağılım ve sıklığının bilinmesi, etkili faktörlerin saptanıp koruyucu önlemler alınması, bebek ölümleri ve toplumda doğuştan engelli birey sayısının azaltılmasına yönelik, atılacak önemli adımlardan birisi olacaktır.
Objective: Our aim is to evaluate the clinical and demographic characteristics of the mothers who has pregnancy with congenital anomaly and was terminationed or delivered in Dicle University Faculty of Medicine Obstetrics and Gynecology clinic and to evaluate the incidence, types of anomalies and distribution of anomalies. According to the results to be revealed; It is aimed to contribute to the reduction of perinatal mortality and morbidity, to decrease the serious health expenses caused by congenital anomalies, the effects of psychological, ethical, social traumas that the family and health personnel and to contribute to the management of fetal anomalies. Material and Methods: Patients (n = 834) who were admitted to Dicle University Medical Faculty Gynecology and Obstetrics Clinic between July 2013 and July 2018 (5 years) with a diagnosis of congenital anomaly and terminated or delivered were included in this study. Data of patients such as age, gravida, parity, gestational week, ultrasonographic findings, type of delivery, gestational week at birth, and congenital anomaly type were obtained by examining the hospital information management system archive and the birth books of our clinic. If the gestational week was ? 20 week or the weigth of fetus is ? 500 gram, pregnancies were accepted as abortion. Minor anomalies and findings (such as choroid plexus cyst, hyperechogenic bowel, short femur, hyperechogenic cardiac focus, mild renal pyelectasis) were excluded from the study. The terminations were done because of the maternal or medical reasons were excluded from the study. Pregnant women with minor anomalies or soft markers but terminated or delivered for different reasons were excluded from the study. Pregnant women who had voluntary abortion without any anomaly were not included the study. Patients whose information could not be obtained from the archive or hospital information management system or incomplete information were excluded from the study. Results: During our study, 834 fetuses with fetal anomalies were delivered. The rate of congenital anomaly in our clinic was determined as 6.12%. When fetal anomalies were evaluated according to system frequencies; SSS anomalies was 426 (51.1%) patients and SSS anomalies was the most common anomalies, skin-lymphatic system anomaly 96 (11.5%), multiple anomalies 87 (10.4%), cardiac anomalies 74 (8,9%), GUS anomalies 59 (7.1%), GIS anomalies 34 (4.1%), musculoskeletal system anomalies 17 (2%), chromosome anomaly 10 (1.2%), chest anomaly 9 (1,1%), cranio-facial anomaly 3 (0.4%) and 18 (2.2%) patients with other anomalies were determined. The most common anomalies as a group; NTD anomalies (n = 199 (23.9%)), hydrocephalus (n = 104, (24.4%)) was the most common isolated anomaly. In the patients with congenital anomalies, the rates of giving birth by cesarean section were higher and this was statistically significant (p <0.001). It was found that there was no relationship between common congenital anomalies and consanguineous marriage or smoking. In our study, it was found that SSS anomalies, skin lymphatic system anomalies and multiple anomalies were observed more frequently in the fetuses of mothers who gave birth before term and this frequency was statistically significant. It was found that SSS anomalies were more common in female fetuses and ambigus genitalia than boys, and this difference was statistically significant (p = 0.037). Conclusion: Early prenatal diagnosis of fetal anomalies and the ability to terminate voluntarily at earlier gestational weeks increased the expectation of pregnant women to give birth to a baby without anomaly and healthy . In addition, it was observed that ethical and psychological acceptability was higher in early terminations. Although there are differences in cultures and laws of countries; We believe that early counseling, especially providing more effective counseling to the family about severe anomalies that are incompatible with life, and the termination option will contribute to the reduction of perinatal mortality and morbidity, and reduce the health expenses and psychological and social traumas that the family will have to experience. It will be one of the important steps to be taken in order to know the distribution and frequency of congenital malformation in every society and even in every region, to determine effective factors and to take preventive measures, to reduce infant mortality and the number of congenitally disabled individuals.
Objective: Our aim is to evaluate the clinical and demographic characteristics of the mothers who has pregnancy with congenital anomaly and was terminationed or delivered in Dicle University Faculty of Medicine Obstetrics and Gynecology clinic and to evaluate the incidence, types of anomalies and distribution of anomalies. According to the results to be revealed; It is aimed to contribute to the reduction of perinatal mortality and morbidity, to decrease the serious health expenses caused by congenital anomalies, the effects of psychological, ethical, social traumas that the family and health personnel and to contribute to the management of fetal anomalies. Material and Methods: Patients (n = 834) who were admitted to Dicle University Medical Faculty Gynecology and Obstetrics Clinic between July 2013 and July 2018 (5 years) with a diagnosis of congenital anomaly and terminated or delivered were included in this study. Data of patients such as age, gravida, parity, gestational week, ultrasonographic findings, type of delivery, gestational week at birth, and congenital anomaly type were obtained by examining the hospital information management system archive and the birth books of our clinic. If the gestational week was ? 20 week or the weigth of fetus is ? 500 gram, pregnancies were accepted as abortion. Minor anomalies and findings (such as choroid plexus cyst, hyperechogenic bowel, short femur, hyperechogenic cardiac focus, mild renal pyelectasis) were excluded from the study. The terminations were done because of the maternal or medical reasons were excluded from the study. Pregnant women with minor anomalies or soft markers but terminated or delivered for different reasons were excluded from the study. Pregnant women who had voluntary abortion without any anomaly were not included the study. Patients whose information could not be obtained from the archive or hospital information management system or incomplete information were excluded from the study. Results: During our study, 834 fetuses with fetal anomalies were delivered. The rate of congenital anomaly in our clinic was determined as 6.12%. When fetal anomalies were evaluated according to system frequencies; SSS anomalies was 426 (51.1%) patients and SSS anomalies was the most common anomalies, skin-lymphatic system anomaly 96 (11.5%), multiple anomalies 87 (10.4%), cardiac anomalies 74 (8,9%), GUS anomalies 59 (7.1%), GIS anomalies 34 (4.1%), musculoskeletal system anomalies 17 (2%), chromosome anomaly 10 (1.2%), chest anomaly 9 (1,1%), cranio-facial anomaly 3 (0.4%) and 18 (2.2%) patients with other anomalies were determined. The most common anomalies as a group; NTD anomalies (n = 199 (23.9%)), hydrocephalus (n = 104, (24.4%)) was the most common isolated anomaly. In the patients with congenital anomalies, the rates of giving birth by cesarean section were higher and this was statistically significant (p <0.001). It was found that there was no relationship between common congenital anomalies and consanguineous marriage or smoking. In our study, it was found that SSS anomalies, skin lymphatic system anomalies and multiple anomalies were observed more frequently in the fetuses of mothers who gave birth before term and this frequency was statistically significant. It was found that SSS anomalies were more common in female fetuses and ambigus genitalia than boys, and this difference was statistically significant (p = 0.037). Conclusion: Early prenatal diagnosis of fetal anomalies and the ability to terminate voluntarily at earlier gestational weeks increased the expectation of pregnant women to give birth to a baby without anomaly and healthy . In addition, it was observed that ethical and psychological acceptability was higher in early terminations. Although there are differences in cultures and laws of countries; We believe that early counseling, especially providing more effective counseling to the family about severe anomalies that are incompatible with life, and the termination option will contribute to the reduction of perinatal mortality and morbidity, and reduce the health expenses and psychological and social traumas that the family will have to experience. It will be one of the important steps to be taken in order to know the distribution and frequency of congenital malformation in every society and even in every region, to determine effective factors and to take preventive measures, to reduce infant mortality and the number of congenitally disabled individuals.
Açıklama
Anahtar Kelimeler
Konjenital anomali, Prenatal tanı, Perinatal morbidite, Perinatal mortalite, Terminasyon, Congenital anomaly, Prenatal diagnosis, Perinatal morbidity, Perinatal mortality, Termination
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Buğday, R. (2020). Kliniğimizdeki konjenital anomali tiplerinin, dağılımının ve konjenital anomalili bebek doğuran gebelerin klinik ve demografik özelliklerinin retrospektif değerlendirilmesi: 5 yıllık tersiyer merkez deneyimi. Uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
