Kliniğimizde serklaj operasyonu yapılmış olan hastalarınretrospektif değerlendirilmesi
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Tarih
2023
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Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada amacımız kliniğimizde uygulanan servikal serklaj hastalarının sonuçlarını değerlendirmek ve serklaj işleminin obstetrik sonuçlar üzerindeki etkisini ortaya koymaktır. Gereç ve Yöntem: Kliniğimizde 01.01.2013 – 01.01.2023 tarihleri arasında servikal yetmezlik tanısıyla serklaj işlemi uygulan olguların verileri retrospektif olarak hasta dosyaları, elektronik veri tabanı ve ulaşılamayan bilgiler için hastalarla telefon görüşmeleri ile toplandı. 12 hafta ile 25 hafta arasında gebeliği olan tekil veya çoğul gebelikler çalışmaya dâhil edildi. Yaşamla bağdaşmayan fetal anomalisi olan, preeklampsi gibi maternal erken doğum riski oluşturabilecek komorbiditesi olan, işlem sırasında servikal açıklığı 4 cm'den büyük olan olgular çalışmaya dâhil edilmedi. Altmış altı olgunun verileri çalışma kriterlerine uygun bulunarak demografik veriler, obstetrik öyküler, güncel gebelik verileri ve güncel gebelik sonuçları kaydedildi. Serklaj kararı alındığında gebelik haftası, serviks uzunluğu, dilatasyonu ve efasmanı, serklaj öncesinde ve sonrasında kullanılan ilaçlar, kullanılan serklaj tekniği, sütür materyali, işlem sırasında ve sonrasında gelişen komplikasyonlar, hastanede yatış süresi, doğum haftası, doğum şekli, bebeklerin doğum ağırlıkları değerlendirildi. Analizlerde SPSS 27.0 programı kullanıldı. p < 0.05 ve p < 0.01 değerleri anlamlı olarak kabul edildi. Bulgular: Çalışmamızda serklaj işlemi uygulanan gebelerin doğum haftasının; 9 hastada (%13,6) <24 hafta öncesi, 14 hastada (%21,2) ?24 – < 34 hafta arasında, 14 hastada (%22,6) ?34 - < 37 hafta arasında, 28 hastada ise (%42,6) ? 37 haftada gerçekleştiği görüldü. 15 bebeğin (%22,7) < 1500 gr, 10 bebeğin (15,2 %) 1500-2500 gr arasında, 41 bebeğin ise (%62,1) ? 2500 gram ağırlığında doğduğu görüldü. Serklaj haftası ile doğum ağırlığı arasında negatif kolerasyon izlenmiş olup bu fark istatiksel olarak anlamlı bulunmuştur (p < 0.01). Serklaj uygulanması sırasındaki gebelik haftası ile doğum haftası karşılaştırıldığında; serklaj uygulama haftası azaldıkça doğum haftasının arttığı görülmüştür. Serklaj haftası ile doğum haftası arasında negatif kolerasyon izlenmiş olup bu fark istatiksel olarak anlamlı bulunmuştur (p < 0.05). Serklaj haftası ile bebeklerin doğum APGAR skorları arasında negatif korelasyon izlenmiş olup erken haftalarda serklaj uygulanan gebelerin fetüslerinin APGAR skorlarında istatistiksel olarak anlamlı artış izlenmiştir (p < 0.01). Serklaj uygulanan hastalarda VKI, hastanın yaşı, gravide parite abortus öyküsü ve geçirilmiş sezaryen, serklaj öyküsünün gebelik haftası ve perinatal sonuçlar açısından istatistiksel olarak anlamlı farklılık göstermemiştir (p > 0.05). Servikal açıklık oranı fazla ve servikal uzunluğu kısa olan hastalara yapılan serklaj operasyonunda gebeliklerin daha erken haftada sonlandığı görülmüştür (p < 0.01). Sonuç: Çalışmamızda serklaj uygulamalarının erken doğumları azalttığını, gebelik süresini uzattığını belirledik. Serklaj ile kazanılan sürenin perinatal sonuçlara olumlu istatistiksel katkısının olduğunu saptadık. Hakkında sınırlı verisi olan serklaj uygulamaları ve perinatal sonuçları ile ilgili çalışmamızın literatüre katkısı olacağı düşüncesindeyiz. Serklaj işlemi uygulanacak olgular uygun koşullar sağlandığı takdirde klinik bulgularla desteklenerek seçilmeli ve serklaj uygulamaları çok iyi seçilmiş, iyi anamnez alınmış olgularda ve özellikle başka bir tedavi olanağı olmayan olgular ile sınırlı tutulmalıdır.
Objective: In this study, our aim is to evaluate the results of cervical cerclage patients applied in our clinic and to reveal the effect of cerclage procedure on obstetric outcomes. Material and Methods: For data of cases who underwent cerclage with the diagnosis of cervical insufficiency between 01.01.2013 and 01.01.2023 in our clinic, retrospectively patient files, electronic database and inaccessible information were collected by telephone interviews with patients. Single or multiple pregnancies with a pregnancy between 12 weeks and 25 weeks were included in the study. Cases with fetal anomaly incompatible with life, comorbidities such as preeclampsia that may pose a risk of maternal preterm birth, and cases with a cervical opening greater than 4 cm during the procedure were not included in the study. The data of sixty-six cases were found to be suitable for the study criteria. Demographic data, obstetric histories, current pregnancy data and current pregnancy outcomes were recorded. When the cerclage decision was taken, the gestational week, cervix length, dilatation and effacement, drugs used before and after cerclage, cerclage technique used, suture material, complications developed during and after the procedure, length of hospital stay, birth week, delivery type, birth weights of the babies were evaluated. SPSS 27.0 program was used in the analysis. P < 0.05 and p < 0.01 values were considered significant. Results: In our study, the week of birth of pregnant women who underwent cerclage; before <24 weeks in 9 patients (13.6%), between ?24 - <34 weeks in 14 patients (21.2%), between ?34 - <37 weeks in 14 patients (22.6%), in 28 patients (42.6%), it was observed that it occurred at ?37 weeks. It was observed that 15 babies (22.7%) were born < 1500 g, 10 babies (15.2%) weighed between 1500-2500 gr, and 41 babies (62.1%) were born ? 2500 grams. Negative correlation was observed between cerclage week and birth weight, and this difference was statistically significant (p < 0.01). When the gestational week and the delivery week are compared during the cerclage application; it was observed that the week of delivery increased as the week of cerclage application decreased. Negative correlation was observed between cerclage week and delivery week, and this difference was statistically significant (p < 0.05). A negative correlation was observed between the cerclage week and the birth APGAR scores of the babies, and a statistically significant increase was observed in the APGAR scores of the fetuses of the pregnant women who had cerclage in the early weeks (p < 0.01). There was no statistically significant difference in BMI, age of the patient, history of gravida parity abortion and previous cesarean section, cerclage history in terms of gestational week and perinatal outcomes in patients who underwent cerclage (p > 0.05). It was observed that pregnancies ended earlier in the cerclage operation performed on patients with a high cervical dilation rate and a short cervical length (p < 0.01). Conclusion: In our study, we determined that cerclage applications reduce preterm births and prolong the gestation period. We determined that the time gained with cerclage has a positive statistical contribution to perinatal outcomes. We think that our study on cerclage applications and perinatal outcomes, which has limited data will contribute to the literature. Cases to be treated with cerclage should be selected supported by clinical findings when appropriate conditions are met and cerclage applications should be limited to well-chosen cases with a good anamnesis especially in cases where there is no other treatment option.
Objective: In this study, our aim is to evaluate the results of cervical cerclage patients applied in our clinic and to reveal the effect of cerclage procedure on obstetric outcomes. Material and Methods: For data of cases who underwent cerclage with the diagnosis of cervical insufficiency between 01.01.2013 and 01.01.2023 in our clinic, retrospectively patient files, electronic database and inaccessible information were collected by telephone interviews with patients. Single or multiple pregnancies with a pregnancy between 12 weeks and 25 weeks were included in the study. Cases with fetal anomaly incompatible with life, comorbidities such as preeclampsia that may pose a risk of maternal preterm birth, and cases with a cervical opening greater than 4 cm during the procedure were not included in the study. The data of sixty-six cases were found to be suitable for the study criteria. Demographic data, obstetric histories, current pregnancy data and current pregnancy outcomes were recorded. When the cerclage decision was taken, the gestational week, cervix length, dilatation and effacement, drugs used before and after cerclage, cerclage technique used, suture material, complications developed during and after the procedure, length of hospital stay, birth week, delivery type, birth weights of the babies were evaluated. SPSS 27.0 program was used in the analysis. P < 0.05 and p < 0.01 values were considered significant. Results: In our study, the week of birth of pregnant women who underwent cerclage; before <24 weeks in 9 patients (13.6%), between ?24 - <34 weeks in 14 patients (21.2%), between ?34 - <37 weeks in 14 patients (22.6%), in 28 patients (42.6%), it was observed that it occurred at ?37 weeks. It was observed that 15 babies (22.7%) were born < 1500 g, 10 babies (15.2%) weighed between 1500-2500 gr, and 41 babies (62.1%) were born ? 2500 grams. Negative correlation was observed between cerclage week and birth weight, and this difference was statistically significant (p < 0.01). When the gestational week and the delivery week are compared during the cerclage application; it was observed that the week of delivery increased as the week of cerclage application decreased. Negative correlation was observed between cerclage week and delivery week, and this difference was statistically significant (p < 0.05). A negative correlation was observed between the cerclage week and the birth APGAR scores of the babies, and a statistically significant increase was observed in the APGAR scores of the fetuses of the pregnant women who had cerclage in the early weeks (p < 0.01). There was no statistically significant difference in BMI, age of the patient, history of gravida parity abortion and previous cesarean section, cerclage history in terms of gestational week and perinatal outcomes in patients who underwent cerclage (p > 0.05). It was observed that pregnancies ended earlier in the cerclage operation performed on patients with a high cervical dilation rate and a short cervical length (p < 0.01). Conclusion: In our study, we determined that cerclage applications reduce preterm births and prolong the gestation period. We determined that the time gained with cerclage has a positive statistical contribution to perinatal outcomes. We think that our study on cerclage applications and perinatal outcomes, which has limited data will contribute to the literature. Cases to be treated with cerclage should be selected supported by clinical findings when appropriate conditions are met and cerclage applications should be limited to well-chosen cases with a good anamnesis especially in cases where there is no other treatment option.
Açıklama
Anahtar Kelimeler
Gebelik, Servikal serklaj, Servikal yetmezlik, Preterm doğum, Pregnancy, Cervical cerclage, Cervical insuffiency, Preterm delivery
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Sengi, A. (2023). Kliniğimizde serklaj operasyonu yapılmış olan hastaların retrospektif değerlendirilmesi. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
